Multimodality Imaging for CAD Detection Before Renal Transplantation.

SEE PAGE 553 T he latest data from the United States Renal Data System indicate that 17,305 renal transplants were performed in the United States in 2012, the majority from deceased donors (1). At the end of 2012, there were 81,981 candidates listed on the transplant list. Although a proportion of these had an inactive status on the waiting list, the imbalance between the availability of organs and the number of candidates clearly poses a challenge for allocating organs; the result is a median wait time to transplantation of 3.6 years. While the kidney transplant list has been growing over the years, the number of kidney transplants performed in the United States has been relatively stable since 2005, indicating that the relative paucity of organs is expected to intensify going forward. Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage renal disease pretransplantation, the leading cause of death in the peri-transplant period, and a major cause of loss of functioning allografts at 10 years after transplantation (2–4). Thus, there is a general consensus on the need for pre-transplant cardiovascular evaluation and risk stratification, although the best strategy to achieve this goal has been controversial. The 2012 scientific statement from the American Heart Association and the American College of Cardiology Foundation on Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates was endorsed by the American Society of Transplant Surgeons, the