Prognostic value of myocardial perfusion imaging in kidney transplant recipients: a systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Kidney transplant recipients are at risk for major adverse cardiac events (MACE) and cardiovascular mortality. We aimed to assess the prognostic value of myocardial perfusion imaging (MPI) single-photon emission computed tomography (SPECT), in patients evaluated for transplantation, for MACE and cardiovascular mortality after kidney transplantation. Methods We performed a systematic literature search in PubMed, EMBASE, Web of Science, OvidSP, The Cochrane Library and Google Scholar. We retrieved studies investigating the prognostic value of MPI for MACE and mortality in kidney transplant recipients. After risk of bias assessment using QUIPS, a meta-analysis was conducted. Results Out of 1379 records, 14 studies (7 prospective and 7 retrospective) using MPI SPECT were included in the meta-analysis with a total of 4643 MPI procedures. No studies were excluded after QUIPS assessment. Median follow-up duration of patients ranged from 1 to 8 years. Kidney transplant recipients with perfusion defects on MPI showed an increased risk for MACE (RR 2.76, 95%-CI 1.73-4.42), cardiovascular mortality (RR 3.15, 95%-CI 1.94-5.13) and all-cause mortality (RR 2.12, 95%-CI 1.76-2.54) compared to recipients with normal MPI findings. Significant heterogeneity existed across the included studies investigating MACE. Conclusions Our results showed that MPI SPECT may identify patients at increased risk for MACE and mortality after kidney transplantation.