Improving Hearts Before Transplant

Kidney and liver transplant candidates need effective screening for cardiovascular risks

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) When patients are awaiting a life-saving kidney or liver transplant, their failing organs are not the only thing they need to worry about; many of these patients also have heart problems.

The American Heart Association and American College of Cardiology Foundation have released new guidelines on screening kidney and liver transplant candidates for heart-related problems.

The guidelines are designed to make cardiovascular testing more consistent across care centers and to reduce testing of little value.

"Protect your heart health if you're awaiting a transplant."

In 2010, nearly 85,000 patients were awaiting a kidney transplant. About 16,000 patients were waiting for a new liver. People with either kidney or liver failure are faced with a higher risk of heart-related problems such as heart disease and high blood pressure.

Due to the large number of patients waiting for kidney and liver transplants, conducting useful and cost-effective cardiovascular tests can be a challenge, said Krista L. Lentine, MD, of Saint Louis University and co-chair of the working group that wrote the recent statement.

Organ shortages that raise concern about fairness and the long periods between testing and transplantation also make it difficult to run effective cardiovascular tests, she said.

To write their statement and make cardiovascular testing more effective, Dr. Lentine and colleagues reviewed the current evidence on cardiovascular testing in kidney and liver transplantation.

Among their conclusions, the authors wrote that there is a need for separate guidelines for kidney and liver patients. While heart disease is a main cause of death among kidney failure patients, liver patients are more often faced with other problems like high blood pressure in the blood vessels of the lungs.

Another recommendation is that coronary revascularization (improving blood flow to the heart) before transplant surgery should be done in patients based on each patient's specific symptoms, heart function and degree of blood vessel blockage.

However, there are patients without obvious signs of heart problems. According to co-chair Salvatore P. Costa, MD, of Dartmouth-Hitchcock Medical School, the risks of coronary revascularization may outweigh the risks of transplantation.

These risks must be gauged by each patient's healthcare team on a case-by-case basis, said Dr. Costa.

The authors also recommended that hospitals name a heart specialist responsible for addressing questions about heart health in transplant candidates.

"Overall, we hope this statement will offer a foundation for centers to coordinate and better standardize cardiac evaluation practices before kidney and liver transplantation according to best available evidence," said Kim A. Eagle, MD, of the University of Michigan.

In the end, the hope is that care centers following the guidelines can reduce heart-related complications and deaths for patients undergoing kidney and liver transplantation, said Dr. Eagle.

Dr. Lentine received research funding from the National Institute of Diabetes and Digestive and Kidney Diseases.

The statement is published in Circulation and the Journal of the American College of Cardiology.

Reviewed by: 
Review Date: 
July 12, 2012
Last Updated:
January 9, 2013