Abstract
The Predictive Capacity of Cardiac Testing and Cardiac History on Kidney Transplant Waitlist Survival
American journal of transplantation, Vol.26(1 Supplement 1), p.S21
01/2026
DOI: 10.1016/j.ajt.2025.12.057
Abstract
Objectives: Cardiac disease is the most common cause of death among renal failure patients and patients awaiting kidney transplantation, making it a focus of waitlist management. However, the predictive benefit of expensive cardiac testing on waitlist survival is not well characterized. Our aim was to evaluate associations of cardiac testing and cardiac history with waitlist survival. Methods:. Following IRB approval 216 variables related to patient demographics, medications, EKGs, echocardiograms, stress tests, and cardiac interventions were collected on 313 patients consecutively listed for kidney transplant between 2015-2020. Outcomes based on listing status comparing transplanted/surviving patients versus patients removed from the waitlist for death/medical reasons were analyzed in univariate and multivariable fashion. Kaplan-Meier analysis based on significant multivariate variables was performed. Results: The mean(±SD) age was 62(±10) years, 95% male, 27% black, and 3.7 years on dialysis at the time of evaluation. The top three causes of renal failure were diabetes (47%), hypertension (23%), and focal segmental glomerulosclerosis (10%). 111 patients were removed from the kidney transplant waitlist due to death or medical reasons. On univariate analysis, demographic factors associated (p<0.05) with waitlist drop-off included age, brain natriuretic peptide (BNP), diabetic renal failure, congestive heart failure, and hyperlipidemia. Significant variables related to cardiac history and medications included current heart failure, angina, statins, aspirin, and hydralazine. Among EKG, echocardiogram, cardiac catheterization, and cardiac stress testing-related variables, atrial flutter, T-wave inversions (ischemia), left anterior descending artery stenosis >70%, peak-minus-baseline heart rate difference, hypokinesis, ejection fraction, and E:E’ ratio were statistically significant (p < 0.05). On multivariable analysis, hydralazine use, BNP, and EKG ischemia remained significantly associated with waitlist drop-off. Comparing groups with two or more of the risks identified on multivariate analysis and those without risk factors, there was a 42% difference in 5-year waitlist survival. Conclusions: BNP greater than 4700 pg/mL, hydralazine use, and EKG ischemia were predictors of waitlist delisting in our cohort. Factors related to advanced cardiac testing did not associate with kidney transplant waitlist survival on multivariate analysis, making the value of expensive testing questionable and a potential barrier to transplant.
Details
- Title: Subtitle
- The Predictive Capacity of Cardiac Testing and Cardiac History on Kidney Transplant Waitlist Survival
- Creators
- Ethan Angle - University of IowaLuke Vaske - University of IowaGrace Binns - Iowa City VA Health Care SystemPromporn Suksaranjit - Iowa City VA Health Care SystemDaniel Katz - University of Iowa
- Resource Type
- Abstract
- Publication Details
- American journal of transplantation, Vol.26(1 Supplement 1), p.S21
- DOI
- 10.1016/j.ajt.2025.12.057
- ISSN
- 1600-6135
- Publisher
- Elsevier
- Language
- English
- Date published
- 01/2026
- Academic Unit
- Cardiovascular Medicine; Surgery; Internal Medicine
- Record Identifier
- 9985130218602771
Metrics
1 Record Views