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Protecting the hearts of those waiting for kidney and liver transplants
Date:7/12/2012

c biomarkers, coronary revascularization and related care before transplantation, and medical management of cardiovascular risk factors before, during and after transplant.

Ten things to know about cardiac evaluation in kidney and liver transplantation candidates

"Adaptation of these guidelines will likely improve uniformity of care across centers and minimize testing of limited value," Christopher deFilipi, M.D., associate professor of medicine at the University of Maryland, writes in an editorial about the statement. "Cohesion of cardiac pre-operative risk assessment and management across centers can't be understated with many transplant candidates seeking listing at multiple centers to potentially improve their chance of transplantation.

"Currently, these patients are often faced with divergent opinions and conflicting requests for pre-operative cardiac testing ranging from no testing to routine coronary angiography," according to deFilipi.

In a survey of centers participating in the United Network for Organ Sharing, 8 percent of programs reported cardiac testing for all listed candidates, and 18 percent did not order routine cardiac testing for any asymptomatic patient group.

The authors address the need for separate guidelines for kidney and liver transplant patients. Kidney transplant recipients may have more common comorbidities, such as diabetes, than patients with liver failure. Heart disease is a common cause of death among those with end-stage kidney failure, while liver transplant candidates face their own unique problems such as pulmonary hypertension.

A main recommendation is that coronary revascularization procedures, including angioplasty which improves blood flow to the heart and relieves chest pain, before transplantation surgery should be considered in patients based on their symptoms, cardiac function and ischemic burden, meaning the extent of blood vessel blockage.

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Contact: Shantell M. Kirkendoll
smkirk@umich.edu
734-764-2220
University of Michigan Health System
Source:Eurekalert

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