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Right Ventricular Dysfunction and Adverse Outcomes after Renal Transplantation
Megan S Joseph1, Francis Tinney2, Abhijit Naik3
1Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School and Michigan Medicine, Ann Arbor, Michigan, USA.
Cardiorenal Medicine
|April 14, 2021
Summary
Right ventricular (RV) dilation and dysfunction are linked to worse outcomes after kidney transplants. Echocardiograms assessing RV function are crucial for pre-transplant cardiovascular risk evaluation in end-stage renal disease patients.
Area of Science:
- Cardiology
- Nephrology
- Transplant Surgery
Background:
- Pulmonary hypertension is frequent in end-stage renal disease (ESRD).
- Limited data exist on right ventricular (RV) failure's impact on post-renal transplant outcomes.
- RV dilation and dysfunction may predict adverse events after transplantation.
Purpose of the Study:
- To investigate the association between echocardiographic RV dilation/dysfunction and clinical outcomes in renal transplant recipients.
- To determine if RV abnormalities predict delayed graft function, graft failure, or all-cause mortality.
Main Methods:
- Retrospective review of adult renal transplant recipients (2008-2010).
- Inclusion of patients with transthoracic echocardiograms (TTEs) within one year pre-transplant.
- Primary endpoint: composite of delayed graft function, graft failure, and all-cause mortality.
Main Results:
- Eighty patients were analyzed with a mean follow-up of 9.4 years.
- 100% of patients with qualitative RV dysfunction met the primary endpoint versus 60% without (p=0.026).
- RV dilation correlated with shorter time to graft failure (p=0.03) and death (p=0.048).
Conclusions:
- RV dilation and dysfunction are significantly associated with adverse outcomes post-renal transplant.
- TTE assessment of RV size and function should be standard in pre-kidney transplant cardiovascular risk stratification.
- Early identification of RV issues can guide management and improve transplant outcomes.
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