Cardiac disease |
Recommendations |
1. All patients should be assessed for the presence of IHD before kidney transplantation. The minimum required investigations include history, physical examination, ECG, and a chest radiograph (Grade A). |
2. Further testing for IHD depends on the pretest probability of CAD. The following patients should have further noninvasive testing: |
I. Symptomatic patients or patients with a prior history of CAD including
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II. Asymptomatic patients with
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3. All patients with a positive noninvasive test should be assessed by a cardiologist with a view to undergoing angiography (Grade B). |
4. Very high-risk patients should be considered for angiography even with a negative noninvasive test (Grade C). |
5. Patients with IHD should be eligible for kidney transplantation if they fall into one of the following categories:
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6. Kidney transplantation is contraindicated in patients with IHD in the following situations:
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7. Patients with IHD should be reevaluated on a regular basis.
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8. LV dysfunction is not necessarily a contraindication to kidney transplantation. LV function should be evaluated in all patients being assessed for transplantation with history, physical examination, ECG, and chest radiography (Grade A). An echocardiogram should be performed in patients with evidence of LV dysfunction (Grade B) or in patients at high risk for LV dysfunction (patients with diabetes, CAD, longstanding hypertension, longstanding kidney disease, or known valvular heart disease) (Grade C). |
9. Uremic LV dysfunction may improve after transplantation; thus, it is not necessarily a contraindication to waitlisting (Grade B). |
10. Patients with severe irreversible (nonuremic) cardiac dysfunction should not be listed for kidney transplantation alone. Selected patients may be candidates for combined heart-kidney transplants (Grade C). |
11. Children with evidence of cardiomyopathy on echocardiography or with congenital heart disease should be evaluated for transplantation in consultation with a pediatric cardiologist (Grade C). |
12. All patients should be monitored for aortic stenosis by history, physical examination, and echocardiogram where clinical suspicion is high (Grade C). |
13. Patients with aortic stenosis should have regular follow-up echocardiograms, and consideration should be given to early surgical intervention as the disease is accelerated in renal failure (Grade C). |
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