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Published on: July 19, 2021
Cardiac Function in Children After Kidney Transplant
Alev Arslan1, Gönül Parmaksız, Zekiye Aytül Noyan
1From the Department of Pediatrics, Division of Pediatric Cardiology, Başkent University Faculty of Medicine, Turkey.
Insights
Renal transplant improves heart function in pediatric patients, with most systolic and diastolic dysfunctions resolving over time. Right ventricle dysfunction recovery is slower post-transplant.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Transplant Medicine
Background:
- Renal transplant is known to improve cardiac function.
- Understanding the specific changes in ventricular function post-transplant is crucial for patient management.
Purpose of the Study:
- To assess the gradual changes in left and right ventricle systolic and diastolic functions in pediatric patients before and after renal transplantation.
Main Methods:
- Echocardiography, including Tissue Doppler imaging, was used to evaluate 30 pediatric kidney recipients.
- Measurements included Tei indices, tricuspid annular plane systolic excursion, and right ventricle systolic excursion velocity.
- Cardiac function was compared pre-transplant with early (6-12 months) and late (>1 year) post-transplant periods.
Main Results:
- Pre-transplant, left ventricle, right ventricle, and interventricular septal Tei indices were elevated, indicating dysfunction.
- Tricuspid annular plane systolic excursion and right ventricle systolic excursion velocity were abnormal in a significant portion of patients pre-transplant.
- Post-transplant, most ventricular function markers improved, though some Tei indices remained elevated, particularly for the right ventricle at late-term follow-up.
Conclusions:
- Systolic and diastolic ventricular dysfunction is common in pediatric renal transplant recipients, especially early post-transplant.
- These dysfunctions tend to decrease over time, indicating a positive impact of renal transplantation.
- Recovery of right ventricle function appears to be a slower process compared to the left ventricle.
Objectives:
Renal transplant improves echocardiographic markers of systolic and diastolic heart functions. The aim of this study was to evaluate the gradual changes in left and right ventricle functions in children and young adults before and after renal transplant.
Materials And Methods:
Thirty kidney recipients of median age 13 years (range, 5-19 years) were included the study. Tissue Dopplerimaging from the septal and lateral mitral annulus ofthe left ventricle and free wall of the right ventricle was performed. Right ventricle systolic excursion velocity and tricuspid annular plane systolic excursion were calculated. Systolic and diastolic heart functions-which gained just before transplant, were compared with posttransplant early- term (6 months to 1 year) and long-term (longer than 1 year) functions.
Results:
Twelve patients received deceased-donor and 18 patients received living donor renal transplant. Follow-up after transplant was 44 ± 23 months. Left ventricle ejection fractions were normal. The left ventricle, right ventricle, and interventricular septalTei indices were significantly higher before transplant.The posttransplantation early- and late-term results of left ventricle,right ventricle, and interventricular septal Tei indices were similar. Tricuspid annular plane systolic excursion levels were abnormal in 11 patients (36%), and right ventricle systolic excursion velocities were abnormal in 7 patients (23%) before transplant. All tricuspid annular plane systolic excursion levels and 94% ofright ventricle systolic excursion velocities were normal, but left ventricle Tei indices were higher in 8 (26%) and right ventricle Tei indices were higher in 14 patients (46%) at late-term follow-up.
Conclusions:
The systolic and diastolic dysfunctions of both ventricles appear to be highly prevalent in pediatric renal transplant recipients, especially soon after transplant, and were shown to usually decrease with time. Improvements in right ventricle dysfunction are slower, even in optimally treated posttransplant patients.
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