Cardiac evaluation of renal transplant candidates with heart failure

Table 1 Summary of recommendations for cardiac evaluation in heart failure and pulmonary hypertension

Cardiovascular disease	Pre-transplant recommendations
Heart failure with reduced ejection fraction	If echocardiographic signs concerning for CHD such as regional wall motion abnormalities, recommend referral to cardiology for intensive GDMT and potential coronary angiography for risk stratification and/or revascularization. If patient requires dialysis, obtain a repeat echocardiography once dry weight has been achieved, usually 1-3 months after the initial echocardiogram
Heart failure with preserved ejection fraction	Optimization of patient's volume status and avoiding hypervolemia
Pulmonary Hypertension	Those patients with severe PH with PAP > 35 mmHg should be referred to a PH specialist for preoperative treatment options
	For patients with group 2 or 5, aggressive volume management pre-transplant is recommended with ultrafiltration as tolerated
	In group 5 PH with AVF flow greater than 30% of their cardiac output, treatment could include ligation of their AVF

CHD: Coronary heart disease; GDMT: Guideline-directed medical therapy; PH: Pulmonary hypertension; PAP: Pulmonary artery pressure; AVF: Arteriovenous fistula.