Prevalence, Predictors, and Outcomes of Coronary Artery Disease Diagnosed by Angiography in Live-Related Kidney Transplant Candidates

Background: This retrospective observational study aimed to determine the prevalence of coronary artery disease (CAD) and its predictors, and to study the impact of CAD on delayed graft function (DGF), acute rejection, graft loss, and mortality. Methods: The study included all successful transplant candidates older than 14 who underwent a coronary angiogram pre-transplant. Binary logistic regression models were constructed to identify factors associated with coronary artery disease (CAD), graft failure, and patient outcomes. Results: Out of 259 patients, 120 (46.33%) kidney transplant recipients (KTRs) underwent angiography. Eighty-four (70%) of the KTRs had a normal angiogram. Twenty (17%) had single-vessel disease, 9 (8%) had two-vessel disease, and 7 (6%) had three-vessel disease. Out of 164 stenotic lesions found, 84 lesions (51.8%) were less than 20% or were normal. Thirty-three lesions (20.1%) had 20–49% stenosis, 15 lesions (9.1%) had 50–70% stenosis, 28 lesions (17.1%) had 70–99% stenosis, and four lesions (2.4%) were completely occluded. Multivariate logistic regression identified age >50 years (OR 8.73, 95% CI: 1.88–40.49, p=0.006), elevated triglyceride levels (OR 1.87, 95% CI: 1.10–3.18, p=0.02), and family history of CAD (OR 5.08, 95% CI: 1.33–19.42, p=0.02) as significant predictors of CAD. Though logistic regression analysis showed that CAD was independently associated with lower GFR only at discharge (OR 0.92, 95% CI: 0.86–0.99, p = 0.03), this effect was not evident at 6 months, 1 year, or 2 years post-transplant. CAD had no statistically significant impact on clinical outcomes, including delayed graft function, graft loss, acute rejection, or mortality, till 2 years of follow-up. Conclusion: CAD has a prevalence of 30% in KTRs. Older age, elevated triglycerides, and a family history of coronary artery disease (CAD) are potential predictors of CAD. While CAD was associated with lower GFR at discharge, it did not significantly affect long-term graft or patient outcomes.