Cardiac Catheterization After Positive Stress Test Improves Post-Kidney Transplant Survival

New research is shedding light on the potential benefits of cardiac catheterization following a positive stress test for improving survival in kidney transplant recipients.1

The data were presented at the 9th Annual Heart in Diabetes Conference in Philadelphia, Pennsylvania, by Sudhanvan Iyer, BSA, of John Sealy School of Medicine at the University of Texas Medical Branch, and suggest the potential value of cardiac catheterization as a targeted intervention in pretransplant cardiac risk stratification.1

Cardiovascular disease is a leading cause of morbidity and mortality among kidney transplant recipients. Death from cardiovascular disease is also the most common cause of graft loss. In the absence of transplant-specific guidelines for pretransplant cardiac risk evaluation, clinicians typically rely on protocols designed for end-stage renal disease patients.1,2

“Cardiac stress testing is commonly used to assess perioperative risk, but a positive result does not reliably lead to further evaluation with cardiac catheterization, and the clinical benefit of doing so in transplant candidates remains unclear,” Iyer and colleagues wrote.1

Seeking to address this gap in evidence-based pretransplant care, investigators assessed the clinical impact of cardiac catheterization following a positive stress test in kidney transplant candidates using retrospective data from the TriNetX Research Network. Specifically, they included adults who underwent kidney transplantation between 2004 and 2024 and had a positive cardiac stress test within 5 years pre-transplant, with or without subsequent cardiac catheterization.1

Investigators divided the cohort into 2 groups: those with a positive pre-transplant stress test who underwent cardiac catheterization (n = 11,940) and those with a positive pre-transplant stress test who did not undergo catheterization (n = 53,243). After propensity score matching based on demographics and cardiovascular comorbidities, 11,612 participants remained in each group.1

The primary outcomes of interest were risk ratios (RR) and confidence intervals (CI) for 1-year all-cause mortality following kidney transplantation.1

Results showed patients who received a cardiac catheterization showed consistently decreased risk of all-cause mortality compared with controls (1.57% vs 1.98%; RR, 1.257; 95% CI, 1.037-1.524; P = .0196).1

Investigators noted improved survival following cardiac catheterization may be driven by several factors, describing minimally invasive coronary angiography’s ability to identify candidates for revascularization procedures such as percutaneous coronary intervention or coronary artery bypass grafting, potentially reducing perioperative cardiac events.1

Additionally, they note catheterization may prompt more intensive medical management, including initiation or adjustment of antiplatelet, statin, or antihypertensive therapies. The procedure also facilitates more accurate cardiovascular risk stratification, enabling tailored perioperative planning and long-term follow-up.1

Looking ahead, Iyer and colleagues encourage future prospective studies to determine which patients are most likely to benefit from this intervention and investigate whether improved outcomes are driven by downstream revascularization procedures, optimization of medical therapy, or enhanced cardiovascular risk stratification.1

“This study suggests that cardiac catheterization following a positive stress test may improve survival in kidney transplant recipients, supporting its potential value as a targeted intervention in pretransplant cardiac risk stratification,” investigators concluded. “These findings highlight the need to move beyond generalized cardiovascular screening protocols and adopt transplant-specific approaches that better reflect the unique risk profile of this population.”

References

1. Iyer S, Shirafkan A, Nguyen P, et al. #0100 A Second Look Cardiac Catheterization and Survival after Kidney Transplantation. Abstract presented at the 9th Annual Heart in Diabetes Conference in Philadelphia, PA, from June 6 - 8, 2025.

2. Vella J, Lentine KL. Risk factors for cardiovascular disease in the kidney transplant recipient. UpToDate. August 16, 2024. Accessed June 7, 2025. https://www.uptodate.com/contents/risk-factors-for-cardiovascular-disease-in-the-kidney-transplant-recipient