Low Prevalence of Class 1 Indications for Coronary Revascularization in Patients Undergoing Prekidney Transplant Screening for Coronary Disease

Background: CVD is the most common cause of morbidity and mortality in kidney transplant recipients. Screening for coronary disease is to reduce the risk of perioperative cardiovascular complications, long term cardiovascular morbidity and mortality is frequently required but coronary intervention has not been shown to be beneficial except in complex coronary disease. The likelihood of finding significant coronary artery disease and benefit of routine pre-transplant screening is uncertain. Methods: We performed a systematic review and meta-analysis to quantify the frequency of detecting significant coronary lesions for which--there are AHA Class 1 indications for revascularization: a) >50% left main stenosis; or b) multi-vessel disease with EF < 35%. Medline & Embase were searched to identify manuscripts reporting the results of pre-transplant screening published between 1998 and 2024. Screening and data collection was performed by 4 independent authors with disagreements resolved by consensus. Quality assessment was performed using the Joanna Briggs Institute scale. This review was registered with PROSPERO. Results: We identified 1281 studies, 148 required full text review out of which 50 met eligibility criteria. We extracted data from 50 studies, 17 studies did not report ejection fraction. The mean prevalence of a class 1 indication across these studies was 5.35 %. Analysis of the number of patients with left main disease, triple vessel disease (without an EF < 35%) will be updated. Conclusion: Identification of class I indications for revascularization during pre-transplant coronary screening is rare and routine screening may not be warranted.