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Published on: August 2, 2024
Effect of left atrial and ventricular abnormalities on renal transplant recipient outcome-a single-center study
Rajan K Patel1, Christopher Pennington2, Kathryn K Stevens1
1BHF Glasgow Cardiovascular Research, University of Glasgow, 126 University Place, Glasgow, G12 8TA UK ; Department of Renal Medicine, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT UK.
Insights
Pre-transplant left ventricular hypertrophy and elevated left atrial volume in kidney transplant candidates predict reduced survival. These cardiovascular abnormalities are key indicators for assessing post-transplant mortality risk.
Area of Science:
- Cardiology
- Nephrology
- Transplantation Medicine
Background:
- Premature cardiovascular death is the leading cause of mortality in renal transplant recipients.
- Uremic cardiomyopathy and left atrial dilation are known risk factors for reduced survival in end-stage renal disease (ESRD) patients.
- Pre-transplant cardiac abnormalities impact post-transplant outcomes.
Purpose of the Study:
- To investigate the impact of pre-transplant left atrial (LA) and left ventricular (LV) abnormalities on survival after renal transplantation (RT).
Main Methods:
- Cardiovascular magnetic resonance (CMR) imaging was performed on 119 renal transplant recipients prior to waitlisting.
- Data on transplant function and patient survival were collected post-transplantation.
- Survival analyses, including multivariate Cox regression, were conducted.
Main Results:
- Pre-transplant LV hypertrophy and elevated LA volume were significantly associated with reduced post-transplant survival.
- Longer waiting time, poorer transplant function, LV hypertrophy, higher LA volume, and female sex were independent predictors of death.
- Median follow-up was 4.3 years, with 23 deaths occurring with a functioning graft.
Conclusions:
- Left ventricular hypertrophy (LVH) and increased LA volume are significant, independent predictors of mortality in patients awaiting or undergoing renal transplantation.
- These findings highlight the importance of pre-transplant cardiovascular screening.
Background:
Premature cardiovascular (CV) death is the commonest cause of death in renal transplant recipients. Abnormalities of left ventricular (LV) structure (collectively termed uremic cardiomyopathy) and left atrial (LA) dilation, a marker of fluid status and diastolic function, are risk factors for reduced survival in patients with end stage renal disease (ESRD). In the present analysis, we studied the impact of pre-transplant LA and LV abnormalities on survival after successful renal transplantation (RT).
Methods:
One hundred nineteen renal transplant recipients (first transplant, deceased donors) underwent cardiovascular MRI (CMR) as part of CV screening prior to inclusion on the waiting list. Data regarding transplant function and patient survival after transplantation were collected.
Results:
Median post-transplant follow-up was 4.3 years (interquartile range (IQR) 1.9, 6.2). During the post-transplant period, 13 patients returned to dialysis after graft failure and 23 patients died with a functioning graft. Survival analyses, censoring for patients returning to dialysis, showed that pre-transplant LV hypertrophy and elevated LA volume were significantly associated with reduced survival after transplantation. Multivariate Cox regression analyses demonstrated that longer waiting time, poorer transplant function, presence of LV hypertrophy and higher LA volume on screening CMR and female sex were independent predictors of death in patients with a functioning transplant.
Conclusions:
Presence of LVH and higher LA volume are significant, independent predictors of death in patients who are wait-listed and proceed with renal transplantation.
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