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Assessment and management of coronary artery disease in kidney and pancreas transplant candidates

Knapper, Joseph Ta; Raval, Zankhanab; Harinstein, Matthew E.c; Friedewald, John J.d,e; Skaro, Anton I.f; Abecassis, Michael I.e; Ali, Ziad A.b; Gheorghiade, Mihaia,†; Flaherty, James D.a

Journal of Cardiovascular Medicine: February 2019 - Volume 20 - Issue 2 - p 51–58
doi: 10.2459/JCM.0000000000000742

Patients with end-stage renal disease (ESRD) undergoing evaluation for kidney and/or pancreas transplantation represent a population with unique cardiovascular (CV) profiles and unique therapeutic needs. Coronary artery disease (CAD) is common in patients with ESRD, mediated by both the overrepresentation and higher prognostic value of traditional CV risk factors amongst this population, as well as altered cardiovascular responses to failing renal function, likely mediated by dysregulation of the renin–angiotensin–aldosterone system (RAAS) and abnormal calcium and phosphate metabolism. Within the ESRD population, obstructive CAD correlates highly with adverse coronary events, including during the peri-transplant period, and successful revascularization may attenuate some of that increased risk. Accordingly, peri-transplant coronary risk assessment is critical to ensuring optimal outcomes for these patients. The following provides a review of CAD in patients being evaluated for kidney and/or pancreas transplantation, as well as evidence-based recommendations for appropriate peri-transplant evaluation and management.

aDepartment of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois

bDepartment of Medicine, Division of Cardiology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York

cDivision of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

dDepartment of Medicine, Division of Nephrology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

eDepartment of Surgery, Division of Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

fDepartment of Surgery, Division of General Surgery and Multi-Organ Transplantation, University of Western Ontario, London, Ontario, Canada

Correspondence to James D. Flaherty, MD, Bluhm Cardiovascular Institute, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA. Tel: +312 926 6422; fax: +312 695 0063; e-mail:

Received 7 June, 2018

Accepted 12 November, 2018

© 2019 Italian Federation of Cardiology. All rights reserved.