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A propensity score–matched analysis indicates screening for asymptomatic coronary artery disease does not predict cardiac events in kidney transplant recipients

A propensity score–matched analysis indicates screening for asymptomatic coronary artery disease does not predict cardiac events in kidney transplant recipients
A propensity score–matched analysis indicates screening for asymptomatic coronary artery disease does not predict cardiac events in kidney transplant recipients
Screening for asymptomatic coronary artery disease prior to kidney transplantation aims to reduce peri- and post-operative cardiac events. It is uncertain if this is achieved. Here, we investigated whether pre-transplant screening with a stress test or coronary angiogram associated with any difference in major adverse cardiac events (MACE) up to five years post-transplantation. We examined a national prospective cohort recruited to the Access to Transplant and Transplant Outcome Measures study who received a kidney transplant between 2011-2017, and linked patient demographics and details of cardiac screening investigations to outcome data extracted from the Hospital Episode Statistics dataset and United Kingdom Renal Registry. Propensity score matched groups were analyzed using Kaplan-Meier and Cox survival analyses. Overall, 2572 individuals were transplanted in 18 centers; 51% underwent screening and the proportion undergoing screening by center ranged from 5-100%. The incidence of MACE at 90 days, one and five years was 0.9%, 2.1% and 9.4% respectively. After propensity score matching based on the presence or absence of screening, 1760 individuals were examined (880 each in screened and unscreened groups). There was no statistically significant association between screening and MACE at 90 days (hazard ratio 0.80, 95% Confidence Interval 0.31-2.05), one year (1.12, 0.51–2.47) or five years (1.31, 0.86-1.99). Age, male sex and history of ischemic heart disease were associated with MACE. Thus, there is no association between screening for asymptomatic coronary artery disease and MACE up to five years post-transplant. Practices involving unselected screening of transplant recipients should be reviewed.

cardiovascular events, coronary artery disease, kidney transplantation, screening
0085-2538
431-442
Nimmo, Ailish
2b61d0d9-2883-4f82-b6e8-e27718812089
Forsyth, John
5684d101-1ef9-41eb-96b5-9a25dbb9ef68
Oniscu, Gabriel
4ccaccea-a2ca-4803-b84d-3abd638af33d
Robb, Matthew
b80210c5-ec66-48f8-88a4-96d7464d2d5e
Watson, Chris
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Fotheringham, James
14f5dec7-4aea-46b4-b92d-9677323dc5e6
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Ravanan, Rommel
7ec93d33-4d6d-442f-9959-7cd0839730be
Taylor, Dominic M.
70995da6-0948-4782-bbc1-b07a8ccff79a
Nimmo, Ailish
2b61d0d9-2883-4f82-b6e8-e27718812089
Forsyth, John
5684d101-1ef9-41eb-96b5-9a25dbb9ef68
Oniscu, Gabriel
4ccaccea-a2ca-4803-b84d-3abd638af33d
Robb, Matthew
b80210c5-ec66-48f8-88a4-96d7464d2d5e
Watson, Chris
928a88f7-f20f-4438-8f30-4f8eaa5948ce
Fotheringham, James
14f5dec7-4aea-46b4-b92d-9677323dc5e6
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Ravanan, Rommel
7ec93d33-4d6d-442f-9959-7cd0839730be
Taylor, Dominic M.
70995da6-0948-4782-bbc1-b07a8ccff79a

Nimmo, Ailish, Forsyth, John, Oniscu, Gabriel, Robb, Matthew, Watson, Chris, Fotheringham, James, Roderick, Paul, Ravanan, Rommel and Taylor, Dominic M. (2021) A propensity score–matched analysis indicates screening for asymptomatic coronary artery disease does not predict cardiac events in kidney transplant recipients. Kidney International, 99 (2), 431-442. (doi:10.1016/j.kint.2020.10.019).

Record type: Article

Abstract

Screening for asymptomatic coronary artery disease prior to kidney transplantation aims to reduce peri- and post-operative cardiac events. It is uncertain if this is achieved. Here, we investigated whether pre-transplant screening with a stress test or coronary angiogram associated with any difference in major adverse cardiac events (MACE) up to five years post-transplantation. We examined a national prospective cohort recruited to the Access to Transplant and Transplant Outcome Measures study who received a kidney transplant between 2011-2017, and linked patient demographics and details of cardiac screening investigations to outcome data extracted from the Hospital Episode Statistics dataset and United Kingdom Renal Registry. Propensity score matched groups were analyzed using Kaplan-Meier and Cox survival analyses. Overall, 2572 individuals were transplanted in 18 centers; 51% underwent screening and the proportion undergoing screening by center ranged from 5-100%. The incidence of MACE at 90 days, one and five years was 0.9%, 2.1% and 9.4% respectively. After propensity score matching based on the presence or absence of screening, 1760 individuals were examined (880 each in screened and unscreened groups). There was no statistically significant association between screening and MACE at 90 days (hazard ratio 0.80, 95% Confidence Interval 0.31-2.05), one year (1.12, 0.51–2.47) or five years (1.31, 0.86-1.99). Age, male sex and history of ischemic heart disease were associated with MACE. Thus, there is no association between screening for asymptomatic coronary artery disease and MACE up to five years post-transplant. Practices involving unselected screening of transplant recipients should be reviewed.

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KI-06-20-1127.R2_Proof - Accepted Manuscript
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Accepted/In Press date: 2 October 2020
e-pub ahead of print date: 7 November 2020
Published date: 1 February 2021
Additional Information: Funding Information: AN, JLF, GCO, MR, CW, PJR, RR, and DMT received funding from the National Institute for Health Research under the Programme Grants for Applied Research scheme (RP-PG-0109-10116) for completion of the Access to Transplantation and Transplant Outcome Measures study. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. Many thanks to the ATTOM research team, the research nurses, and the patients in the study. AN performed the analyses, produced the figures and tables, and wrote the manuscript under the supervision of DMT, RR, and PJR. JF assisted with manipulation of Hospital Episode Statistics data and statistical analyses and contributed to manuscript preparation. All other authors were members of the Access to Transplantation and Transplant Outcome Measures research group, who gave editorial and methodological advice and contributed to manuscript preparation. Publisher Copyright: © 2020 International Society of Nephrology Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: cardiovascular events, coronary artery disease, kidney transplantation, screening

Identifiers

Local EPrints ID: 447374
URI: http://eprints.soton.ac.uk/id/eprint/447374
ISSN: 0085-2538
PURE UUID: 9f674ecf-11c2-4e67-bca1-448754d88715
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850

Catalogue record

Date deposited: 10 Mar 2021 17:38
Last modified: 07 Nov 2021 05:01

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Contributors

Author: Ailish Nimmo
Author: John Forsyth
Author: Gabriel Oniscu
Author: Matthew Robb
Author: Chris Watson
Author: James Fotheringham
Author: Paul Roderick ORCID iD
Author: Rommel Ravanan
Author: Dominic M. Taylor

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