2-024 Real world experience of a cardio-renal MDT at a tertiary cardiac and renal transplant centre

Background Patients with end-stage kidney disease (ESKD) face a significant burden of cardiovascular disease,¹ impacting their eligibility and outcomes for renal transplant.² The Cardio-Renal Multi-Disciplinary Team (CR-MDT) was established at Manchester University NHS Foundation Trust (MFT) in 2022, to optimise cardiovascular risk and management in transplant candidates, in line with the 2020 Kidney Disease: Improving Global Outcomes (KDIGO) pre-transplant guidance.³ Risk is stratified based upon symptoms and age, followed by myocardial perfusion scanning (MPS). Patients with abnormal MPS are referred to the CR-MDT for discussion and if required, further workup and revascularisation prior to clearance for transplant. Aim This study evaluated the characteristics of patients referred to the CR-MDT, indication for referral, and the extent of subsequent investigation and revascularization. Methods Retrospective analysis of 190 patients discussed from May 2022 to November 2024. Data collected included referral indications, baseline cardiovascular risk factors, diagnostic investigations performed (MPS, CT coronary angiography (CTCA), invasive angiography (IA)), and revascularization strategies including both percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG). Results Tables 1 and 2 summarise the demographic characteristics of the group. The most common indication for referral was abnormal MPS (101, 53%) followed by abnormal echocardiography (33, 17%) (figure 1). A total of 118 patients (62.2%) required further cardiology input whilst, the remaining patients were either cleared for transplant without further assessment 33 (17.3%) or deemed unsuitable for transplant. Of those who required further input, 84 patients (44% of the whole group) required IA, 10 patients required CTCA, and 7 patients required Cardiac MR. Revascularization through PCI or CABG was planned or performed in 13 (6.8%) patients and 7 patients (3.7%), respectively (figure 2). In the 20 patients who have been transplanted having passed through the CR-MDT, there have been no peri-operative cardiovascular complications. Conclusion A substantial proportion of patients required further cardiac investigations, with just under half undergoing invasive angiography and a smaller percentage requiring revascularization. Future work will focus on collecting further outcome data, refining screening protocols, evaluating cost effectiveness and streamlining the MDT workflow. References Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Circulation 2021;143(11):1157–72. Goyal P, et al. Clin Transplant. 2021;e14083. doi: 10.1111/ctr.14083 Chadban SJ, Ahn C, Axelrod DA, Foster BJ, Kasiske BL, Kher V, et al. Transplantation 2020;104(4S1):S11–103.