Myocardial Perfusion Scans and Mortality in Asymptomatic Patients Awaiting Renal Transplantation A. Jauhal a , S. Harenberg b , J.J. Crawford b , I. Bare a , B. Prasad a,b , L. Zahorski b , G. Ollenberger a,b,c , V. Trivedi a,b,c , V. Chopra d , A. Shoker a,b , A. Lavoie a,b,d , and P. Dehghani a,b,d, * a College of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada; b Regina Qu’Apelle Health Region, Regina, Saskatchewan, Canada; c Department of Medical Imaging, University of Saskatchewan, Regina, Saskatchewan, Canada; and d Prairie Vascular Research Network, University of Saskatchewan, Regina, Saskatchewan, Canada ABSTRACT Cardiac risk assessment for asymptomatic patients awaiting renal transplantation is controversial. Patients awaiting renal transplantation in Southern Saskatchewan from 2005 to 2015 were retrospectively reviewed. Patients underwent cardiac risk stratification with stress myocardial perfusion scan. Baseline clinical characteristics, nuclear scan results, all- cause mortality, and cardiovascular events were analyzed. Abnormal scans were defined as studies with reversible defects, wall motion abnormalities, lung uptake, or transient ischemic dilation. Descriptive statistics and survival analysis were calculated. Charts from 285 consecutive patients with 608 nuclear scans were analyzed. Mean age was 55.2  11.7 years and 34.7% were female. Forty-three (15.1%) patients were transplanted and 99 (40.9%) patients died while awaiting renal transplantation. One hundred fifty-three pa- tients (63.2%) had at least one abnormal scan. The mean follow-up period was 5.47  3.11 years. An abnormal scan was not associated with decreased survival and/or coronary events (hazard ratio: 0.94, P ¼ .77; 95% confidence intervals: 0.62 to 1.43). Patients awaiting renal transplantation in Saskatchewan with abnormal myocardial perfusion scans were not at greater risk of death or coronary events. C HRONIC kidney disease (CKD) is a known risk factor for coronary artery disease (CAD) [1]. Atypical pre- sentations in CKD populations lead to delay in diagnosis of CAD [2]. Conventional risk factors (smoking, diabetes, hypertension, dyslipidemia, and advanced age) coupled with CKD-specific risk factors, including inflammation, oxidative stress, endothelial dysfunction, calcification, hyper- homocysteinemia, and immunosuppression [3], lead to accelerated atherosclerosis. Renal transplantation is the treatment of choice for those with end-stage renal disease (ESRD) [4]. Cardiac evaluation before renal trans- plantation assists in risk stratifying patients with CAD with the hope of reducing peri- and postoperative cardiac mortality. However, cardiovascular disease remains a sig- nificant cause of morbidity and mortality for the ESRD population, both in the pretransplantation [5] and post- transplantation population [4,5]. Optimal preoperative investigation of the patient awaiting renal transplantation remains an area of contro- versy. Although guidelines have been put in place regarding the clinical context in which noninvasive cardiac evaluation should proceed, the evidence behind these decisions is lacking. The general perioperative American College of Cardiology (ACC)/American Heart Association (AHA) guidelines are only designed for short-term risk assessment of CAD and do not incorporate the long-term risk assessment required in kidney transplantation candi- dates [6]. However, they do acknowledge that the trans- plantation population has its own set of unique cardiac risk factors in their consensus document, specifically addressing cardiac evaluation in kidney and liver transplantation candidates. Their ultimate recommendations are quoted from the 2007 Lisbon Conference Report; a working group that acknowledges screening asymptomatic individuals *Address correspondence to Payam Dehghani, MD, Regina General Hospital Unit 3A (CCU), Interventional Cardiology Research Office, 1440-14th Ave, Regina, Saskatchewan, Canada S4P 0W5. E-mail: pdehghani@mac.com ª 2017 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169 0041-1345/17 https://doi.org/10.1016/j.transproceed.2017.07.003 Transplantation Proceedings, 49, 2011e2017 (2017) 2011