Association and prognostic impact of persistent left ventricular hypertrophy after live-donor kidney transplantation: a prospective study

Effect of Renal Transplantation on Left Ventricular Myocardial Deformation in Patients With End-Stage Renal Disease

BACKGROUND

End-stage renal disease (ESRD) is associated with significant left ventricular (LV) remodeling. However, the impact of renal transplantation on LV remodeling has not been adequately elucidated.

METHODS

A comprehensive echocardiography was performed before and after (median time interval 239 days, interquartile range 149-328 days) renal transplantation in 42 patients (mean age 39.1 ± 11.0 years, 79% men). Forty-five apparently healthy age- and gender-matched controls were also included.

RESULTS

The patients with ESRD had significantly increased LV mass index, left atrial volume index (LAVI), and the ratio of early diastolic mitral inflow velocity to mitral annular velocity (E/e'), whereas LV global longitudinal strain (GLS), circumferential strain, apical rotation, and twist were reduced. LV ejection fraction (LVEF) was also lower, but the LV global radial strain (GRS) was not different between the two groups. Most of these abnormalities showed improvement after renal transplantation. Nearly one-third of all patients had at least a 10% improvement in LVEF, and roughly half had a 10% or more improvement in the mitral E/e' ratio and the LV global longitudinal and circumferential strain.

CONCLUSION

This study shows that renal transplantation results in a significant regression of LV hypertrophy and an improvement in LV myocardial deformation translating into an improvement in the LV systolic and diastolic function. Further larger and long-term studies are needed to identify the predictors and the clinical significance of these changes.

Left heart function and strain for predicting change in hemoglobin levels in pediatric kidney transplantation recipients

Introduction

Anemia is prevalent after kidney transplantation (KTx) and is associated with reduced graft survival. The associations between temporal changes in hemoglobin (Hb) level in the early posttransplant period with left ventricular (LV) and atrial (LA) function and strain are unknown.

Methods

The study cohort included 71 successful pediatric KTx recipients between January 2021 and September 2022. Echocardiography was used to evaluate the cardiac structure, function, and strain both before and after KTx. Temporal changes in Hb values within 6 months after KTx were evaluated. According to the LV mass index (LVMI), recipients were divided into a left ventricular hypertrophy (LVH) group and a non-LVH group.

Results

Before KTx, the LVH group had a lower level of Hb and a higher incidence of anemia than the non-LVH group. However, this difference between the groups disappeared after KTx. Changes in Hb were faster in the LVH group than in the non-LVH group. There was a negative association between the absence of an Hb increase and diastolic blood pressure, the LVMI, early diastolic mitral annulus velocity to early diastolic filling wave ratio (E/E'), and the left atrial emptying volume index (LAEVI), while there was a positive association between LV ejection fraction (LVEF), LV global longitudinal strain, and LA strain. The LVMI and changes in LVEF showed a negative correlation, whereas changes in the LAEVI showed a positive correlation with the absence of Hb increase during the early period after KTx.

Conclusion

Children with LVH have a lower level of Hb before KTx and a higher level of Hb increase in the early postoperative period following KTx. LVMI and changes in LVEF and LAEVI have predictive value in absence of Hb increase in pediatric KTx recipients.

Renal Allograft Function Is a Risk Factor of Left Ventricular Remodeling After Kidney Transplantation

BACKGROUND

Cardiovascular disease is the leading cause of morbidity and mortality in kidney transplantation (KT) patients. The prevalence of left ventricular hypertrophy increases with the progression of renal insufficiency.

METHODS

We investigated the association between the progression of renal insufficiency and left ventricular hypertrophy after KT. We reviewed KT patients at Seoul National University Hospital from January 1973 to December 2009. The creatinine elevation ratio (CER, the percentage change in the creatinine level from 1 month to 5 years after transplant) was calculated as follows: (creatinine level at 5 years minus creatinine level at 1 month)/creatinine level at 1 month × 100.

RESULTS

The study population was classified into a high-CER group (CER ≥25%) and low-CER group (CER <25%). Mean left ventricular mass index (LVMI) values were 135.7 and 134.7 g/m² before KT and 101.7 and 123.7 g/m² at 5 years after KT in the low-CER and high-CER groups, respectively. The LVMI before or 1 year after KT was not different between the 2 groups, but the LVMI at 5 years post-transplant was higher in the high-CER group than in the low-CER group. The LVMI increased after its initial decrease in the high-CER group, whereas its reduction was maintained in the low-CER group during the 5 years after KT (P = .009, repeated-measures analysis of variance).

CONCLUSIONS

These data suggest that deterioration of renal allograft function is associated with left ventricular remodeling after KT.

The Pros and Cons of Preserving a Functioning Arteriovenous Fistula after Kidney Transplantation

The autologous arteriovenous fistula (AVF) for hemodialysis burdens the cardiovascular system with increased cardiac output and pulmonary artery pressure, increasing cardiovascular risk. This article reviews literature on the benefits and drawbacks of a functioning AVF after kidney transplantation and discusses the cardiovascular effects of AVF closure. Several cohort studies demonstrate a significant cardiac burden of an AVF and improvement of cardiac dimensions after AVF ligation. However, no randomized trials have been conducted on routine AVF closure after successful kidney transplantation. Therefore, clinical trials are warranted to evaluate whether the cardiovascular benefits of routine AVF closure outweigh the potential harm for patients after successful kidney transplantation.