Top Things to Know: Emerging Evidence on Coronary Heart Disease (CHD) Screening in Kidney and Liver Transplantation Candidates
Published: October 17, 2022
Prepared by Johanna A. Sharp, MSN RN
- Coronary heart disease (CHD) is a cause of mortality and morbidity for kidney and liver transplant candidates and recipients. This is due to traditional and nontraditional risk factors and a somewhat unique pathophysiology present in patients without end-stage organ disease.
- This scientific statement discusses evidence from the last decade related to CHD screening, and management for kidney and liver transplant candidates and emphasizes multi-disciplinary engagement, including a dedicated cardiologist.
- CHD is defined as a history of myocardial infarction, revascularization (coronary artery bypass grafting or percutaneous coronary intervention) or known ≥50% stenosis in a major epicardial coronary artery. CHD screening refers to testing modalities used to detect the presence of previously unknown but clinically significant CHD.
- In considering kidney transplant candidates, this scientific statement suggests CHD screening, in an algorithm format, to distinguish between candidates without or with known CHD.
- In considering liver transplant candidates, the scientific statement suggests CHD screenings based on a risk assessment approach, presented in an algorithm format.
- Two divergent epidemiological trends in liver transplant candidates are considered in this scientific statement: the changing demographics of liver transplant candidates leading to an increasing prevalence of CHD risk factors, and medical management leading to decreased rates of CHD-related morbidity and rising rates of non-coronary cardiac events after liver transplant.
- The recent evidence from the 2020 International Study of Comparative Health Effectiveness with Medical and Invasive Approaches–Chronic Kidney Disease trial emphasize the importance of guideline-directed medical therapy in managing diagnosed CHD, and considers the variables of revascularization among asymptomatic kidney transplant candidates.
- Transplant is a multidisciplinary process and provides an example of an integrated delivery system (IDS), with collaboration among surgery, medicine, pharmacy, and social work for the care of every candidate, which is required by Organ Procurement and Transplant Network (OPTN).
- Even though cardiovascular evaluation plays a central role that in the consideration for transplant candidacy, there are no regulatory requirements to include cardiologists and/or intensive care physicians in transplant candidacy evaluation and selection.
- Optimizing strategies to disseminate and implement best practices for goal directed medical therapy in the broader end-stage organ disease population should be prioritized to improve cardiovascular outcomes for kidney and liver transplant patients.
Cheng XS, VanWagner LB, Costa SP, Axelrod DA, Bangalore S, Norman SP, Herzog CA, Lentine KL; on behalf of the American Heart Association Council on the Kidney in Cardiovascular Disease and Council on Cardiovascular Radiology and Intervention. Emerging evidence on coronary heart disease screening in kidney and liver transplantation candidates: a scientific statement from the American Heart Association [published online ahead of print October 17, 2022]. Circulation. doi: 10.1161/CIR.0000000000001104