Cardiovascular Outcomes in Kidney Transplant Recipients With ADPKD

Area of Science:

• Nephrology
• Cardiology
• Transplantation Medicine

Background:

• Cardiovascular disease is a major cause of mortality in kidney failure patients.
• Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a systemic condition associated with cardiac abnormalities.
• Limited data exists on the cardiovascular profile and progression in ADPKD patients undergoing kidney transplantation (KT).

Purpose of the Study:

• To assess cardiovascular abnormalities via echocardiography in ADPKD patients at the time of KT.
• To compare the cardiac profile of ADPKD patients with non-ADPKD patients (diabetic nephropathy and non-diabetic) undergoing KT.
• To evaluate major adverse cardiovascular events (MACEs) and survival rates post-KT in ADPKD patients.

Main Methods:

• Retrieved echocardiographic data within 2 years prior to KT (1993-2020).
• Compared cardiovascular parameters in ADPKD patients (n=271) against matched non-ADPKD cohorts: diabetic nephropathy (DN, n=271) and non-diabetic non-ADPKD (NDNA, n=271).
• Analyzed MACEs and survival outcomes post-transplantation.

Main Results:

• ADPKD patients exhibited lower rates of left ventricular hypertrophy (LVH), mitral, and tricuspid regurgitations pre-KT compared to DN and NDNA groups.
• ADPKD patients demonstrated less diastolic and systolic dysfunction at transplantation.
• ADPKD recipients had superior post-KT survival (18.7 years) and MACE-free survival (HR=0.51, P<0.001) but showed worsening valvular function and increased sinus of Valsalva diameter post-transplant.

Conclusions:

• ADPKD kidney transplant recipients possess a more favorable pre-transplantation cardiac profile.
• These patients benefit from better survival and reduced MACE rates after transplantation.
• Long-term monitoring is warranted due to observed post-transplant increases in sinus of Valsalva diameter and valvular function changes.