Abstract
Cardiovascular disease is the leading cause of death among dialysis patients on the kidney transplant list. Moreover, cardiovascular events tend to cluster within the first three months of transplant, and most patients who die with a functioning organ in the first year after transplant died from a cardiovascular cause. Although revascularization tends to benefit patients at the highest risk of events, the end-stage kidney disease (ESKD) population has not been appropriately represented in revascularization clinical trials. A combination of clinical factors, exercise tolerance, noninvasive functional testing, as well as invasive angiography in association with physiological testing can contribute to an appropriate decision of whom to revascularize. Published data from clinical trials focusing on the best strategies for revascularization in this population are scarce at the current time; however, it seems that surgical revascularization has an advantage over percutaneous interventions for dialysis patients with multivessel coronary artery disease (MVCAD), diabetes and patients with complex anatomy. The focus of this chapter is to review the diagnostic tools that facilitate the decision to revascularize patients on the kidney transplant waiting list, and the data supporting both surgical and percutaneous revascularization.