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- Title
Association of Pretransplant Coronary Heart Disease Testing With Early Kidney Transplant Outcomes.
- Authors
Cheng, Xingxing S.; Liu, Sai; Han, Jialin; Stedman, Margaret R.; Baiocchi, Michael; Tan, Jane C.; Chertow, Glenn M.; Fearon, William F.
- Abstract
Key Points: Question: Is testing for coronary heart disease before kidney transplant associated with reduced early posttransplant death or myocardial infarction? Findings: In this quasiexperimental, instrumental variable analysis cohort study of 79 334 adult, Medicare-insured, first-time kidney transplant recipients in the US from 2000 to 2014, testing within 12 months before kidney transplant was not associated with any change in death or myocardial infarction within 30 days after transplant (rate difference [reference, no testing], 1.9%; 95% CI, 0%-3.5%). Meaning: The study results suggest that the current practice of testing for coronary heart disease before kidney transplant may not be associated with reduced adverse outcomes early after transplant. Importance: Testing for coronary heart disease (CHD) in asymptomatic kidney transplant candidates before transplant is widespread and endorsed by various professional societies, but its association with perioperative outcomes is unclear. Objective: To estimate the association of pretransplant CHD testing with rates of death and myocardial infarction (MI). Design, Setting, and Participants: This retrospective cohort study included all adult, first-time kidney transplant recipients from January 2000 through December 2014 in the US Renal Data System with at least 1 year of Medicare enrollment before and after transplant. An instrumental variable (IV) analysis was used, with the program-level CHD testing rate in the year of the transplant as the IV. Analyses were stratified by study period, as the rate of CHD testing varied over time. A combination of US Renal Data System variables and Medicare claims was used to ascertain exposure, IV, covariates, and outcomes. Exposures: Receipt of nonurgent invasive or noninvasive CHD testing during the 12 months preceding kidney transplant. Main Outcomes and Measures: The primary outcome was a composite of death or acute MI within 30 days of after kidney transplant. Results: The cohort comprised 79 334 adult, first-time kidney transplant recipients (30 147 women [38%]; 25 387 [21%] Black and 48 394 [61%] White individuals; mean [SD] age of 56 [14] years during 2012 to 2014). The primary outcome occurred in 4604 patients (244 [5.3%]; 120 [2.6%] death, 134 [2.9%] acute MI). During the most recent study period (2012-2014), the CHD testing rate was 56% in patients in the most test-intensive transplant programs (fifth IV quintile) and 24% in patients at the least test-intensive transplant program (first IV quintile, P <.001); this pattern was similar across other study periods. In the main IV analysis, compared with no testing, CHD testing was not associated with a change in the rate of primary outcome (rate difference, 1.9%; 95% CI, 0%-3.5%). The results were similar across study periods, except for 2000 to 2003, during which CHD testing was associated with a higher event rate (rate difference, 6.8%; 95% CI, 1.8%-12.0%). Conclusions and Relevance: The results of this cohort study suggest that pretransplant CHD testing was not associated with a reduction in early posttransplant death or acute MI. The study findings potentially challenge the ubiquity of CHD testing before kidney transplant and should be confirmed in interventional studies. This instrumental variable analysis examines the association of pretransplant coronary heart disease testing with rates of death and myocardial infarction.
- Publication
JAMA Internal Medicine, 2023, Vol 183, Issue 2, p134
- ISSN
2168-6106
- Publication type
Article
- DOI
10.1001/jamainternmed.2022.6069