340 Does cardiac risk quantification have a role in assessment for Pancreas Transplantation?
Monday November 16, 2015 from 15:30 to 17:00
Room 110

Hussein A Khambalia, United Kingdom

Transplant Registrar

Department of Transplantation

Manchester Royal Infirmary


Does cardiac risk quantification have a role in assessment for Pancreas Transplantation?

Hussein Khambalia1,2, Daniel Doherty1,2, Petros Yiannoullou1, Emma Foster1, Zia Moinuddin1,2, Angela Summers1,2, Titus Augustine1,2, David van Dellen1,2.

1Department of Transplantation, Manchester Royal Infirmary, Manchester, United Kingdom; 2University of Manchester, Manchester, United Kingdom

Introduction: Pancreas transplantation (PT) is the gold-standard treatment for complicated insulin dependent diabetes mellitus. Perceptions of high cardiac risk persist, which currently mandate exhaustive cardiac investigations prior to listing. However, the validity of this approach is not verified and requires further examination.
Methods: Retrospective analysis was made of patients undergoing PT in a single UK centre, examining cardiac assessment and transplant outcomes. Patients were categorised by myocardial perfusion scan (MPS) into normal perfusion (NP), reversible ischaemia (RI) and permanent ischaemia (PI) groups. Primary endpoints were cardiac death, patient and graft survival. Secondary endpoints were hospital length of stay (HLoS), reoperations and complications.
Results: 314 PTs were performed (01/01-03/14), with 152 MPS results available. (60.1% male; mean age 43.8, 82.9% SPK, 12% PAK, PTA 5.1%). 109 (71.7%) MPS showed NP, 24 (15.8%) RI and 12 (7.9%) PI. There was no difference in graft and patient survival between groups (p=0.31, 0.33 (log rank test)). No significant difference was seen for HLoS (NP: 32.7; RI: 53.3 PI: 35.0), mean reoperation number (NP: 0.8, RI: 0.8, PI: 1.0) or complications (NP: 2.4, RI: 1.0, PI: 1.4) (p=0.45, 0.12, 0.89 (ANOVA)).
Angiography was performed in 11.1%, 100% and 83.3% of patients in NP, RI and PI groups respectively since 2011 with no subsequent revascularisations as a result of investigations. Of patients with available MPS results, cardiac causes accounted for 6.5% (n=2; NP: 1, RI: 1) of 31 deaths with median follow-up time from transplant was 1224 days (IQR=2230).
Conclusion: In our single centre experience, MPS poorly stratifies outcome prediction for cardiovascular mortality and angiography appears unnecessary, ultimately resulting in a delay to listing. Post-operative cardiac mortality is minimal compared to waiting list, suggesting a requirement for expedited workup.

© 2018 Melbourne2015