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©2013 UpToDate ® Print Email Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation, continued Cardiac disease Recommendations 1. All patients should be assessed for the presence of ischemic heart disease (IHD) before kidney transplantation. The minimum required investigations include history, physical examination, electrocardiogram (ECG) and a chest radiograph (Grade A). 2. Further testing for IHD depends on the pretest probability of coronary artery disease (CAD). The following patients should have further non-invasive testing: I. Symptomatic patients or patients with a prior history of CAD including Previous history of myocardial infarction (Grade A) Symptoms of angina (Grade A) Signs or symptoms of heart failure (Grade A) II. Asymptomatic patients with Diabetes (type 1 or type 2) (Grade B) Multiple risk factors for CAD (3 or more) (Grade B) - age >50 years - prolonged duration of chronic kidney disease - family history of CAD (first-degree relative) - significant smoking history - dyslipidemia (high-density lipoprotein level <0.9 mmol/L or total cholesterol >5.2 mmol/L), BMI ≥30 kg/m2 - history of hypertension 3. All patients with a positive non-invasive test should be assessed by a cardiologist with a view to undergoing angiography (Grade B). 4. Very high-risk patients should be considered for angiography even with a negative non-invasive test (Grade C). 5. Patients with IHD should be eligible for kidney transplantation if they fall into 1 of the following categories: Low-risk asymptomatic patients (Grade A) Asymptomatic patients with negative non-invasive testing (Grade B) Patients who have undergone successful intervention (Grade B) Patients who on angiography have non-critical disease and are on appropriate medical therapy (Grade C) 6. Kidney transplantation is contraindicated in patients with IHD in the following situations: Patients with progressive symptoms of angina (Grade A) Patients with a myocardial infarction within 6 months (Grade A) Patients without an appropriate cardiac workup (Grade C) Patients with severe diffuse disease, especially with positive non-invasive tests in whom intervention is not possible and in whom expected survival is sufficiently compromised so that transplantation is not reasonable (Grade C)

Patients with a myocardial infarction within 6 months (Grade A) Patients without an appropriate cardiac workup (Grade C) Patients with severe diffuse disease, especially with positive non-invasive tests in whom intervention is not possible and in whom expected survival is sufficiently compromised so that transplantation is not reasonable (Grade C) * The strength of evidence supporting each recommendation was graded using the system developed by the Canadian Task Force on Preventive Health Care as follows: Grade A - There is good evidence to support Grade B - There is fair evidence to support Grade C - The existing evidence is conflicting, but other factors may influence decision-making Grade D - There is fair evidence to recommend against Grade E - There is good evidence to recommend against Reproduced with permission from: Knoll, G, Cockfield, S, Blydt-Hansen, T, et al. Canadian Society of Transplantation: Consensus guidelines on eligibility for kidney transplantation. CMAJ 2005; 173:S1. Copyright © 2005 CMA Media Inc.