Introduction More than 50% of renal transplant recipients will die as a consequence of cardiovascular disease (CVD). Type I diabetics undergoing simultaneous pancreas-kidney transplantation (SPK) are at an even greater risk of CVD. Optimising a patient′s cardiovascular status is necessary before SPK transplant surgery. Patients can remain on transplant waiting lists for years. There is little evidence as to how frequently repeat cardiovascular risk assessments are required in asymptomatic patients. Myocardial perfusion scintigraphy is used in SPK patients to detect any asymptomatic myocardial ischaemia or abnormal left ventricular function. This study analyses data from a SPK transplant centre with an annual surveillance programme to aim to establish the suitable frequency of MPS.
Methods Potential SPK transplant recipients who had undergone two perfusion scans were included for analysis. An abnormal MPS was defined as either showing a regional wall motion abnormality, inducible ischaemia, or impaired left ventricular function. The scan results were both documented and compared. Angiography results from the study period were also recorded.
Results 99 out of 130 patients on the SPK waiting list in November 2009 had undergone two perfusion scans as part of their pre-transplant assessment. The median age was 45 yrs (range 26–63), with 41% female and a median time between scans of 1.4 yrs (range 0.6–3.0). 59 patients (60%) had two consecutive normal scans. The remaining 40 patients had at least one abnormal scan. 16% of patients with a normal 1st scan developed an abnormal 2nd scan within a median period of 1.4 years. 28 (70%) of the patients with an abnormal MPS underwent angiography, of these 12 required revascularisation (either PCI or CABG). Of the remaining 16 patients; 1 died before angiography and the other 15 patients were treated with medical therapy. Of the 59 patients with two normal scans; 3 underwent angiography during the study period (for new symptoms), 1 of these patients required revascularisation after presenting with an ACS. 2 had minor plaque disease.
Conclusions 40% of SPK patients on the waiting list have an abnormal MPS. Of the patients with normal scans 5% required an angiogram because of new symptoms with only 2% requiring revascularisation. Of the patients undergoing angiography driven by MPS 43% subsequently underwent revascularisation. The current screening interval is successfully monitoring changes in the patients' cardiovascular status with only one patient requiring an intervention which was not predicted by MPS. Therefore a near annual MPS is a useful, non-invasive means by which to monitor patients at very high risk of asymptomatic cardiovascular disease while awaiting a SPK transplant.
- SPK transplant
- cardiovascular disease