Abstracts of the 17th Annual Meeting of the American Society of Transplant Physicians, May 9-13, 1998, Chicago, Illinois
At What Creatinine Level is Angiographic Dye safe for Coronary Angiography in Cardiac Transplant Recipients?
Angiographic dye has been known to cause worsening renal function in patients with underlying kidney disease. There has been concern that the use of angiographic dye for annual coronary angiography in heart transplant recipients with renal insufficiency may lead to oliguria and the need for hemodialysis. We studied 70 heart transplant recipients between 1 and 10 years from transplant who had serum creatinine between 2.0 and 4.0 mg/dl prior to angiography. Cardiac catheterization included left ventriculography and selective coronary angiography with between 100 to 200 ml of Omnipaque iodinated contrast (Nycomed, Princeton, NJ) administered. All patients were given 25 mg of mannitol at the start of the procedure and patients with serum creatinine ≥ 3.0 mg/dl were started on renal dose dopamine at 3 mcg/kg/min during the angiogram and for 6 hours after the procedure. Intravenous fluids were administered for 6 hours following the procedure. Serum creatinine(± SE) at baseline, at 1 month, at 3 months, and at 6 months following the procedure were not significantly different (seegraph). No patient necessitated hemodialysis due to the angiographic dye. Three patients had serum creatinine rise to ≥ 4.0 mg/dl between 1 and 6 months after the procedure which appeared to be unrelated to the effects of the angiographic dye.
Conclusion: Coronary angiography in heart transplant patients with serum creatinine between 2.0 and 4.0 mg/dl can be administered safely. Concomitant intravenous mannitol, fluids, and renal dose dopamine may help to maintain renal function during angiography.© 1998 by Lippincott Williams & Wilkins