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Effect of renal transplantation for chronic renal disease on left ventricular mass
Omkar U Vaidya1, John A House, Tina R Coggins
1Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
Insights
Successful renal transplantation significantly reduces left ventricular (LV) mass in most chronic kidney disease patients. Pre-transplant LV mass is the key factor predicting this regression.
Area of Science:
- Cardiology
- Nephrology
- Transplantation Medicine
Background:
- Chronic kidney disease (CKD) is linked to increased left ventricular (LV) mass.
- Limited data exist on LV mass changes post-renal transplantation and predictors of regression.
Purpose of the Study:
- To evaluate the effect of renal transplantation on LV mass regression.
- To identify clinical factors associated with LV mass regression after transplantation.
Main Methods:
- Retrospective analysis of 105 CKD patients undergoing renal transplantation.
- Echocardiography performed before transplantation and ≥1 year after.
- LV mass calculated using established formulas; regression analyzed against clinical variables.
Main Results:
- 57% of patients showed significant LV mass regression (mean -37.2 g/m²).
- 48% had no significant regression (mean +15.7 g/m²).
- Higher pre-transplant LV mass was the sole predictor of regression (OR 1.50).
Conclusions:
- Renal transplantation leads to significant LV mass regression in the majority of patients.
- The degree of LV mass prior to transplantation is the primary clinical predictor of regression.
Abstract:
Chronic kidney disease is associated with an increased left ventricular (LV) mass. Few data are available regarding the effect of renal transplantation on LV mass regression or the clinical factors associated with LV mass regression. Patients with ≥1 year of chronic kidney disease followed by successful renal transplantation were identified. All patients underwent echocardiography ≥6 months before transplantation with repeat echocardiography ≥1 year after transplantation. An experienced echocardiographer, who was unaware of the clinical data, performed all linear measurements in the parasternal long-axis projection, including systolic and diastolic LV chamber dimensions and LV wall thickness. The LV mass was calculated as follows: 0.8 × {1.04 [(LV internal dimension at end diastole + posterior wall thickness at end diastole + LV wall thickness at the cardiac base for the anteroseptum)(3) - (LV internal dimension at end diastole)(3)]} + 0.6 g. Candidate clinical variables for an association with LV mass regression were assembled, including age, gender, race, donor type, renal disease etiology, medications (insulin, oral hypoglycemics, antihypertensives, statins, and antirejection medications), and co-morbidities. Patients were separated into 2 groups according to presence and absence of LV mass regression. A total of 105 patients (mean age 54 years; 58 men) were included in the study with a mean follow-up of 1.7 years. Of the 105 patients, 57 had significant LV mass regression (mean difference -37.2 ± 31.3 g/m(2)) and 48 had no significant regression (mean difference 15.7 ± 17.1 g/m(2)). The extent of the LV mass before transplantation was the only predictor of mass regression after transplantation (odds ratio 1.50, 95% confidence interval 1.26 to 1.80). In conclusion, significant LV mass regression is present in most patients after renal transplantation. The extent of the LV mass before transplantation was the only clinical predictor of regression.
