Cardiac functional and morphologic changes of renal allograft recipients in the early posttransplant period

Evaluation of left atrial remodeling in kidney transplant patients using cardiac magnetic resonance imaging

BACKGROUND

Increased left atrial (LA) size predicts cardiovascular events in patients with end-stage kidney disease. There is a paucity of data on LA changes after kidney transplantation (KT). Accordingly, we used cardiac magnetic resonance imaging (CMR) to evaluate LA remodeling after KT, and examined its relationship with left ventricular (LV) measurements, blood pressure and cardiac biomarkers.

METHODS

In this prospective multi-center cohort study, 39 pre-transplant dialysis patients underwent KT and 42 eligible transplant recipients remained on dialysis. CMR, blood pressure and serum measurements for N-terminal pro b-type natriuretic peptide (NT-proBNP), high sensitivity C-reactive protein (hsCRP), and growth differentiation factor-15 (GDF-15) were performed at baseline and 12 months.

RESULTS

After 12 months, there were no significant changes in LA end-systolic volume index, LA end-diastolic volume index, or LA ejection fraction (LAEF) within the KT or dialysis group; changes over time did not differ between the 2 groups (all p > 0.25). At baseline and over 12 months, LA volumes and LAEF positively correlated with LV volumes and mass while LAEF positively correlated with LV function. Changes in LA volumes also positively correlated with NT-proBNP and systolic blood pressure (sBP) while LAEF negatively correlated with NT-proBNP. GDF-15 correlated with LA measurements at baseline but not in 12-month changes. hsCRP did not correlate with any LA measurements.

CONCLUSIONS

LA volumes and function as measured by CMR did not change significantly over 12 months post-KT. There were significant associations between LA and LV remodeling, NT-proBNP and sBP, suggesting common underlying pathophysiological mechanisms.

Impact of renal transplantation on cardiac morphological and functional characteristics in children and adults

AIM

To compare the effects of renal transplantation on cardiac functions in children and adults.

METHODS

One hundred and ten patients attending the nephrology outpatient clinic were enrolled in this study and were divided into six groups. The first two groups consisted each of 30 renal transplant patients who had a successful renal transplantation more than six months, but less than one year. Group I were less than 18 years and group II were more than 18 years. The third and fourth groups, each were 20 chronic renal failure patients on regular hemodialysis. Again, group III were less than 18 years and group IV were more than 18 years. Group V and VI (The control Groups) consisted each of 5 subjects below and above 18 years of age, respectively with normal kidney functions. All patients were subjected to history and examination. The kidney functions and the hemoglobin were analyzed. After obtaining informed consent, echocardiography was done to all patients.

RESULTS

There was a statistically significant improvement (P < 0.0001) in all cardiac parameters. A regression in left ventricular end diastolic volume (LVED) both in children (4.7 ± 0.8 to 4.2 ± 0.5) and in adults (5.9 ± 0.7 to 4.9 ± 0.6) were found. There was a regression in left ventricular end systolic volume (LVES) both in children (3.1 ± 0.6 to 2.4 ± 0.4) and in adults (4.1 ± 0.9 to 3.1 ± 0.5). Fractional shortening improves both in children (32.6 ± 5.3 to 41.7 ± 7.6) and in adults (29.0 ± 6.6 to 36.5 ± 4.1). The improvement in ejection fraction (EF) was higher in children (59.7 ± 7.0 to 71.9 ± 6.1) than in adults (52.0 ± 12.5 to 64.8 ± 5.9). However, this degree of improvement (in children: 12.2 ± 5.1) did not show statistical difference (P-value 0.8), when compared to adults (12.7 ± 9.8).

CONCLUSION

After renal transplantation cardiac functions and morphology (EF/LVED/LVES) do improve markedly and rapidly in both children and adults.

Left atrial diameter and survival among renal allograft recipients

BACKGROUND AND OBJECTIVES

Sequential echocardiography is routinely performed in patients with ESRD listed for transplantation. The benefit of this labor- and time-intensive measure, however, remains unclear. Thus, this study elucidated the various obtained routine echocardiography parameters that best predicted mortality and graft survival after renal transplantation.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This study investigated 553 first renal transplant recipients listed in the Austrian Dialysis and Transplant Registry between 1992 and 2011 who had echocardiographic analysis at transplantation and survived at least 1 year. Cox proportional hazards models with the purposeful selection algorithms for covariables were used to identify predictors of mortality and graft loss. A Fine and Gray model was used to evaluate cause-specific death.

RESULTS

During a median follow-up of 7.14 years, 81 patients died, and 59 patients experienced graft loss after the first year. The Kaplan-Meier analysis showed that 85% of patients with a left atrial diameter below the median of 53 mm were alive 10 years after transplantation, whereas only 70% of those patients with a left atrial diameter equal to or above the median had survived (P<0.001). In the multivariable model, left atrial diameter (per millimeter) independently predicted overall mortality (hazard ratio, 1.06; 95% confidence interval, 1.03 to 1.08; P<0.001) and cause-specific cardiac death (hazard ratio, 1.04; 95% confidence interval, 1.00 to 1.08; P=0.04). Functional graft loss was predicted by the right atrial diameter (hazard ratio, 1.04; 95% confidence interval, 1.02 to 1.07; P=0.001).

CONCLUSION

The left atrial diameter determined at transplantation predicted overall and cardiac mortality. Patients with widely enlarged left atria exhibit a considerably reduced life expectancy. It remains to be determined, however, whether renal transplantation is futile in these patients.

Cardiac dysfunction after renal transplantation; incomplete resolution in pediatric population

BACKGROUND

Long-term data of cardiac function after renal transplantation (RT) are limited, especially in children. Thus, we evaluated the status of left ventricular hypertrophy and various indices of left ventricular (LV) function in pediatric RT patients.

METHODS

Blood pressure, serum biochemical profiles, electrocardiogram, and echocardiogram of 32 pediatric patients (mean age, 15.5+/-4.4 years) who underwent RT 5.1+/-2.5 years before and 29 body surface area-matched control subjects were studied.

RESULTS

Repolarization abnormalities shown on electrocardiogram of pre-RT patients improved significantly after RT (QTc dispersion 50.8+/-37.3 to 37.4+/-11.9 msec, P=0.009). Left ventricular hypertrophy with increased LV mass index of pre-RT patients regressed remarkably after RT (LV mass index 120.9+/-40.5 to 69.2+/-14.5 g/m2, P<0.001); still, LV mass was significantly higher in RT patients than the controls (54.0+/-9.6 g/m2, P<0.001). Compared with the controls, the RT patients showed diastolic dysfunction (lower E/A ratio and higher isovolumic relaxation time) and lower myocardial performance (higher LV Tei index and weaker strain pattern). Patients who had shorter duration of non-RT renal replacement therapy showed better LV function (lower LV Tei index and stronger strain pattern) in the long-term follow-up.

CONCLUSIONS

Because cardiac dysfunction did not resolve after RT in pediatric population, regular evaluation for cardiovascular function after RT is required. Early RT may also be beneficial to global LV performance after RT.

Changes in cardiac parameters of renal allograft recipients: a compilation of clinical, laboratory, and echocardiographic observations

INTRODUCTION

This study was undertaken to observe changes in cardiac parameters along with clinical and laboratory changes after renal transplantation.

PATIENTS AND METHODS

Cardiac parameters were evaluated by M-mode 2-dimensional echocardiography before transplantation and at monthly intervals. All subjects had functioning grafts at the time of the evaluations.

RESULTS

Fifty-two allograft recipients underwent pretransplant parameters for comparison to those at posttransplant months 1, 3, 6, and 12. When changes at month 1 and 3 were observed among 22 patients, improvements were evident at month 3. Comparisons of pretransplant versus month 3 showed systolic blood pressure (SBP), 161 +/- 16 to 133 +/- 26 mmHg (P < .002); diastolic BP (DBP), 101 +/- 9 to 86 +/- 11 mmHg, (P < .006); hemoglobin (Hgb), 7.3 +/- 1.6 to 11.2 +/- 3.9 g/dL (P < .006); left atrial diameter (LAD), 41 +/- 5 to 35 +/- 3 mm (P < .001); left ventricular muscle mass index (LVMI), 379 +/- 114 to 248 +/- 58 g/m2 (P < .001); and left ventricular end diastolic volume index (LVEDVI), 96 +/- 28 to 64 +/- 17 mL/m2 (P < .002). When changes at months 3, 6, and 12 were observed among 30 patients, improvements evident at month 3 were maintained. Comparisons of pretransplant and 3 and 12 months observations showed SBP, 157 +/- 17, 131 +/- 14, to 126 +/- 10 mm Hg (P < .001); DBP, 97 +/- 10, 83 +/- 16, to 85 +/- 6 mmHg (P < .001); Hgb, 7 +/- 1, 13 +/- 2, to 13 +/- 2 g/dL (P < .001); LAD, 39 +/- 7, 35 +/- 3, to 34 +/- 4 mm (P < .05); LVMI, 275 +/- 91, 191 +/- 38, to 159 +/- 26 g/m2 (P < .001); and LVEDVI, 87 +/- 29, 56 +/- 34, to 49 +/- 24 mL/m2 (P < .001).

CONCLUSION

Significant improvements in cardiac parameters were evident by the third month post-renal transplantation; the changes were maintained over a longer period among patients with functional grafts.