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©2013 UpToDate ® Print Email Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation, continued Cardiac disease, continued Recommendations, continued 7. Patients with IHD should be re-evaluated on a regular basis. Re-evaluation should include history, physical examination, ECG and non-invasive testing (Grade C) Re-evaluation should occur any time a patient becomes symptomatic (Grade A) Re-evaluation should occur annually in all patients who are at high risk (see previous recommendation for high-risk groups) (Grade C) A repeat angiogram may be considered in patients with known IHD before transplantation if waiting time has been prolonged and it is known that a transplant is likely within the next year (Grade C) All high-risk patients on the waiting list should be treated aggressively with risk-factor reduction strategies (Grade A) 8. Left ventricular (LV) dysfunction is not necessarily a contraindication to kidney transplantation. LV function should be evaluated in all patients being assessed for transplantation with history, physical examination, ECG and chest radiography (Grade A). An echocardiogram should be performed in patients with evidence of LV dysfunction (Grade B) or in patients at high risk for LV dysfunction (patients with diabetes, CAD, longstanding hypertension, longstanding kidney disease or known valvular heart disease) (Grade C). 9. Uremic LV dysfunction may improve after transplantation; thus it is not necessarily a contraindication to wait listing (Grade B). 10. Patients with severe irreversible (non-uremic) cardiac dysfunction should not be listed for kidney transplantation alone. Selected patients may be candidates for combined heart-kidney transplants (Grade C). 11. Children with evidence of cardiomyopathy on echocardiography or with congenital heart disease should be evaluated for transplantation in consultation with a pediatric cardiologist (Grade C). 12. All patients should be monitored for aortic stenosis by history, physical examination and echocardiogram where clinical suspicion is high (Grade C). 13. Patients with aortic stenosis should have regular follow-up echocardiograms, and consideration should be given to early surgical intervention as the disease is accelerated in renal failure (Grade C).

12. All patients should be monitored for aortic stenosis by history, physical examination and echocardiogram where clinical suspicion is high (Grade C). 13. Patients with aortic stenosis should have regular follow-up echocardiograms, and consideration should be given to early surgical intervention as the disease is accelerated in renal failure (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.