Impact of kidney transplantation vs. dialysis waiting for deceased donor on left ventricular diastolic dysfunction

Left ventricular (LV) diastolic dysfunction is frequently observed in patients with end-stage kidney disease (ESKD) and a significant risk factor for the development of cardiovascular events in those patients. We hypothesized that the ratio of early diastolic peak mitral flow velocity to early mitral annulus velocity (E/e' ratio), the widely used non-invasive LV diastolic dysfunction index, would show improvements following kidney transplantation (KT).

A total of 192 KT recipients who underwent echocardiography before KT and 2 years after KT were included this analysis. Moreover, 137 patients with ESKD on dialysis, waiting for deceased donor were included as a control group. Multiple linear regression analysis was used to identify the factors related to changes in the E/e' ratio.

The median duration between conducting the two echocardiographies was 809 days for the KT recipients and 798 days for the controls. The mean E/e' ratio showed a significant decrease in KT recipients (10.9 vs. 9.8, respectively; p = 0.002), but not in the controls (11.7 vs. 11.9, respectively; p = 0.605). In multiple linear regression, KT (standardized β (SB) = -0.156; p = 0.009) and administration of β blocker (BB) at enrollment (SB = -0.130; p = =0.034) and at 2 years (SB = 0.206, p = 0.001) were significant predictors of the change in the E/e' ratio.

LV diastolic dysfunction showed a noticeable improvement in the patients after KT compared to those on the waiting list and undergoing dialysis. Further studies, including patients with volume status and major cardiovascular events, may be helpful for validating these findings.