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Cardiovascular Outcomes in Kidney Transplant Recipients With ADPKD
Maroun Chedid1, Hasan-Daniel Kaidbay1,2, Stijn Wigerinck1
1Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) show better heart health before kidney transplantation. ADPKD patients experience improved survival rates post-transplant, despite some later cardiac changes.
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.
Introduction:
Cardiovascular disease leads to high morbidity and mortality in patients with kidney failure. Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a systemic disease with various cardiac abnormalities. Details on the cardiovascular profile of patients with ADPKD who are undergoing kidney transplantation (KT) and its progression are limited.
Methods:
Echocardiographic data within 2 years before KT (1993-2020), and major adverse cardiovascular events (MACEs) after transplantation were retrieved. The primary outcome is to assess cardiovascular abnormalities on echocardiography at the time of transplantation in ADPKD as compared with patients without ADPKD matched by sex (male, 59.4%) and age at transplantation (57.2 ± 8.8 years).
Results:
Compared with diabetic nephropathy (DN, n = 271) and nondiabetic, patients without ADPKD (NDNA) (n = 271) at the time of KT, patients with ADPKD (n = 271) had lower rates of left ventricular hypertrophy (LVH) (39.4% vs. 66.4% vs. 48.6%), mitral (2.7% vs. 6.3% vs. 7.45) and tricuspid regurgitations (1.8% vs. 6.6% vs. 7.2%). Patients with ADPKD had less diastolic (25.3%) and systolic (5.6%) dysfunction at time of transplantation. Patients with ADPKD had the most favorable post-transplantation survival (median 18.7 years vs. 12.0 for diabetic nephropathy [DN] and 13.8 years for nondiabetic non-ADPKD [NDNA]; P < 0.01) and the most favorable MACE-free survival rate (hazard ratio = 0.51, P < 0.001). Patients with ADPKD had worsening of their valvular function and an increase in the sinus of Valsalva diameter post-transplantation (38.2 vs. 39.9 mm, P < 0.01).
Conclusion:
ADPKD transplant recipients have the most favorable cardiac profile pretransplantation with better patient survival and MACE-free survival rates but worsening valvular function and increasing sinus of Valsalva diameter, as compared with patients with other kidney diseases.
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