Technetium myocardial perfusion scanning in prerenal transplant evaluation in the United kingdom.
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Affiliation
Department of Nephrology and Transplantation, Royal Liverpool University Hospital, Liverpool, United Kingdom. chriswong@doctors.org.ukIssue Date
2008-06MeSH
Coronary AngiographyCoronary Disease
Dobutamine
Exercise Test
Female
Great Britain
Heart
Heart Diseases
Humans
Kidney Transplantation
Male
Middle Aged
Preoperative Care
Risk Assessment
Technetium Tc 99m Sestamibi
Tomography, Emission-Computed, Single-Photon
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Technetium myocardial perfusion scanning in prerenal transplant evaluation in the United kingdom. 2008, 40 (5):1324-8 Transplant. Proc.Publisher
Transplantation proceedingsJournal
Transplantation proceedingsDOI
10.1016/j.transproceed.2008.03.143PubMed ID
18589097Abstract
Because death with a functioning graft remains one of the most important causes of long-term renal transplant failure, cardiac risk stratification and screening for coronary artery disease are essential components of pretransplant assessment. Pretransplant screening for occult coronary artery disease in a subset of these patients may improve outcome. The UK follows the European Best practice guideline 1.5.5 E. Although echocardiography, thallium myocardial perfusion scanning (MPS), dobutamine stress echocardiography, and coronary angiography have been suggested as means of cardiovascular assessment, the best means of assessment remains undetermined. Therefore, we investigated the role of 99m technetium sestamibi myocardial perfusion scanning as an assessment tool for identifying those patients with end-stage renal failure at high risk of cardiovascular death after renal transplantation. Retrospectively, we studied 126 patients that had a MPS as part of their pretransplant assessment. Overall unadjusted survival was 65% at 3 years. Twelve deaths resulted from cardiovascular causes. A reversible defect on MPS was associated with a fatal cardiac event and all-cause mortality. The unadjusted hazard ratio of cardiac event with reversible defect on MPS was 3.1 (95% confidence interval, 1.1 to 18.2) and hazard ratio of death with reversible defect on MPS was 1.92 (95% confidence interval, 1.1 to 4.4). Thus, MPS may be a useful tool in cardiac risk stratification and in selecting patients with a favorable outcome after renal transplantation. Our patients with a reversible defect in particular have increased cardiac mortality. This group may benefit from coronary angiography.Item Type
ArticleLanguage
enISSN
0041-1345ae974a485f413a2113503eed53cd6c53
10.1016/j.transproceed.2008.03.143
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