Testing for coronary heart disease before kidney transplant may not lower adverse outcomes
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Testing for coronary heart disease within 12 months before kidney transplantation did not correlate with a change in death or myocardial infarction within 30 days after the transplant, according to data published in JAMA Internal Medicine.
Therefore, researchers suggest that testing for coronary heart disease (CHD) may not reduce the risk of adverse outcomes after a transplant.
“Despite the ubiquity of the practice, to our knowledge, a positive association of CHD screening with [kidney transplant] outcomes has not been demonstrated,” Xingxing S. Cheng, MD, MS, from the division of nephrology and the department of medicine at Stanford University School of Medicine in California, and colleagues wrote. They added, “The goal of this study was to test the hypothesis that pre-transplant CHD testing was associated with a lower rate of cardiac events after [kidney transplant].”
In a retrospective cohort study, researchers examined data of 79,334 adults who were first-time kidney transplant recipients between January 2000 and December 2014 in the U.S. Renal Data System. Patients had at least 1 year of Medicare enrollment prior to and following transplantation.
With a composite of death or acute myocardial infarction (MI) within 30 days after kidney transplant as the primary outcome, researchers considered receipt of nonurgent invasive or noninvasive CHD testing during the year before transplantation.
Researchers conducted an instrumental variable (IV) analysis with the program-level CHD testing rate in the year of the transplant as the IV, then stratified analyses by study period.
Overall, 2.6% of patients died, 2.9% experienced acute MI and 5.3% of patients experienced the composite outcome. Between 2012 and 2014, researchers identified the CHD testing rate as 56% in patients in the most test-intensive transplant programs and 24% in patients at the least test-intensive transplant program.
Analyses revealed CHD testing did not correlate with a change in the rate of primary outcome when compared with no testing. Results remained consistent across study periods, excluding 2000 to 2003 when CHD testing was associated with a higher event rate (rate difference was 6.8%).
“This quasi-experimental cohort study using program-level CHD testing as an IV was unable to demonstrate that pre-transplant CHD testing was associated with reduced early death and MI within 30 days of [kidney transplant],” Cheng and colleagues wrote. “There is even a potential signal that CHD testing was associated with harm during the earlier study eras. Ideally, a U.S.-based [randomized controlled study] can verify or disprove these results. However, in places where such a study is not possible, pragmatic studies in countries with less perceived regulatory pressure and a more integrated health delivery system offer the best hope.”
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