Cardiac Risk Assessment

Pancreas transplantation (PTX) is an attractive therapeutic option for patients with insulin dependent (IDDM) as it allows for an insulin-free life with normal glucose control. Recent advancements in the surgical and medical care of PTX recipients have improved patient and graft survival rates. Currently, cardiovascular disease (CVD) and its complications remain significant causes of morbidity and mortality following PTX. Careful pre-transplant screening for CVD is critical to the short- and long-term success of PTX. Candidates for simultaneous pancreas and kidney (SPK) and pancreas after kidney (PAK) transplantation are typically considered to be at high risk due to the presence of multiple comorbidities and the likelihood of having established cardiovascular disease (CVD). Initial screening with a history and physical, electrocardiogram and echocardiogram establish a baseline clinical risk profile. Contemporary practice calls for a more liberal use of non-invasive studies such as stress testing to further define the burden of CAD and the need for invasive coronary angiography. The benefit from revascularization in PTX candidates remains uncertain but is recommended for those with life-threatening coronary artery disease (CAD).