Cardiovascular Assessment Before Kidney Transplantation: Bridging the Gap Between Guidelines and Clinical Practice
5 affiliations
- 1Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, 41124 Modena, Italy
- 2Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
- 3Anesthesia and Intensive Care Unit, University Hospital of Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
- 4Surgical Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
- 5Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena “Policlinico”, University of Modena and Reggio Emilia, 41124 Modena, Italy
Abstract
Cardiovascular assessment before kidney transplantation (KT) remains uncertain despite contemporary guidelines. Historically, many transplant centers have adopted intensive screening strategies to detect obstructive coronary artery disease (CAD), often resulting in stress testing, coronary angiography, revascularization, dual antiplatelet therapy, and potentially delayed transplantation. However, evidence that systematic detection and prophylactic treatment of stable CAD improve outcomes in asymptomatic KT candidates remains limited. Recent American, British, and European guidance increasingly supports more selective, risk-adapted assessment, yet the low level of supporting evidence leaves substantial discretion in patient and test selection, as well as wait-list surveillance. This implementation gap is particularly relevant for historically high-testing centers seeking to revise established protocols. Moreover, the cardiovascular phenotype of advanced chronic kidney disease extends beyond obstructive epicardial CAD and includes myocardial, microvascular, structural, and systemic abnormalities that may be better captured by physiological vulnerability and functional reserve. Exercise-based assessment may therefore provide prognostic information beyond ischemia detection. In this Viewpoint, we examine the evidence challenging intensive CAD-centered screening, discuss the evolving role of functional testing and risk-adapted surveillance, and illustrate how these principles were translated into a multidisciplinary local protocol revision. The emerging challenge is not simply to perform fewer tests but to identify who truly benefits from additional testing and to select the right test for the right patient at the right time.
Related
- Cardiac Denervation and Reinnervation After Heart Transplantation: Assessment and Clinical Impact
- Deep-Learning-Based Assessment of Breast Arterial Calcification on Mammography: Technical Validation, Cardiovascular Prognostic Value, and Clinical Translation—A Narrative Review
- Syndrome-oriented CNS infectious complications after hematopoietic stem-cell transplantation and CAR T-cell therapy, part 1—viral encephalitis, meningitis, and myelitis: recommendations from the Practice Harmonization & Guidelines Committee of the EBMT
- Clinical Assessment and Exercise Rehabilitation of Sarcopenia in Cardiovascular Disease
- Echocardiographic Assessment and Clinical Applications of the Left Atrial Stiffness Index in Cardiovascular Disease
BibTeX
@article{barbieri2026cardiovascular,
title = {{Cardiovascular Assessment Before Kidney Transplantation: Bridging the Gap Between Guidelines and Clinical Practice}},
author = {Andrea Barbieri and Giacomo Mori and Filippo Bondi and Alessio Bragagni and Alice Parmigiani and Niccolò Morisi and Floriana Cannito and Gaetano Alfano and Gian Piero Guerrini and Barbara Catellani and Giuseppe Boriani and Gabriele Donati},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218565},
url = {https://www.mdpi.com/2077-0383/15/21/8565},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Cardiovascular Assessment Before Kidney Transplantation: Bridging the Gap Between Guidelines and Clinical Practice
AU - Andrea Barbieri
AU - Giacomo Mori
AU - Filippo Bondi
AU - Alessio Bragagni
AU - Alice Parmigiani
AU - Niccolò Morisi
AU - Floriana Cannito
AU - Gaetano Alfano
AU - Gian Piero Guerrini
AU - Barbara Catellani
AU - Giuseppe Boriani
AU - Gabriele Donati
PY - 2026
DA - 2026/11/03
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218565
UR - https://www.mdpi.com/2077-0383/15/21/8565
AB - Cardiovascular assessment before kidney transplantation (KT) remains uncertain despite contemporary guidelines. Historically, many transplant centers have adopted intensive screening strategies to detect obstructive coronary artery disease (CAD), often resulting in stress testing, coronary angiography, revascularization, dual antiplatelet therapy, and potentially delayed transplantation. However, evidence that systematic detection and prophylactic treatment of stable CAD improve outcomes in asymptomatic KT candidates remains limited. Recent American, British, and European guidance increasingly supports more selective, risk-adapted assessment, yet the low level of supporting evidence leaves substantial discretion in patient and test selection, as well as wait-list surveillance. This implementation gap is particularly relevant for historically high-testing centers seeking to revise established protocols. Moreover, the cardiovascular phenotype of advanced chronic kidney disease extends beyond obstructive epicardial CAD and includes myocardial, microvascular, structural, and systemic abnormalities that may be better captured by physiological vulnerability and functional reserve. Exercise-based assessment may therefore provide prognostic information beyond ischemia detection. In this Viewpoint, we examine the evidence challenging intensive CAD-centered screening, discuss the evolving role of functional testing and risk-adapted surveillance, and illustrate how these principles were translated into a multidisciplinary local protocol revision. The emerging challenge is not simply to perform fewer tests but to identify who truly benefits from additional testing and to select the right test for the right patient at the right time.
SN - 2077-0383
ER -