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Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Silent cardiac burden: Echocardiographic abnormalities and their predictors in kidney transplant candidates and their
Nihal Mohammed Sadagah1, Muhammad Abdul Mabood Khalil2, Hinda Hassan Khideer Mahmood1
1Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital Jeddah, Jeddah 23311, Saudi Arabia.
Insights
Pre-transplant echocardiograms reveal common cardiac abnormalities like left ventricular hypertrophy (LVH) and pulmonary hypertension (PH) in kidney transplant candidates. These findings, while prevalent, do not impact long-term kidney graft function.
Area of Science:
- Cardiology
- Nephrology
- Transplantation
Background:
- Echocardiography is crucial for evaluating potential kidney transplant recipients (KTRs).
- Cardiac abnormalities persist in KTRs despite clearance, necessitating identification of prevalence and predictors.
- Optimizing pre-transplant risk stratification is vital for improving post-transplant outcomes.
Purpose of the Study:
- Determine the prevalence of left ventricular hypertrophy (LVH), left ventricular systolic dysfunction (LVSD), diastolic dysfunction (DD), and pulmonary hypertension (PH) in KTRs.
- Identify predictors for these echocardiographic abnormalities.
- Assess the impact of these abnormalities on graft function post-transplant.
Main Methods:
- Analysis of baseline echocardiograms from 259 successful transplant candidates over 14 years old.
- Utilized binary logistic regression to identify factors associated with LVH, LVSD, DD, and PH.
Main Results:
- Prevalence: LVH (64%), LVSD (12%), DD (27.5%), PH (25.5%).
- Predictors identified for LVH (male gender, PH, DD, dyslipidemia), LVSD (DD, family history of CAD), DD (peritoneal dialysis), and PH (LVH, mitral regurgitation).
- No significant impact of these echocardiographic abnormalities on estimated glomerular filtration at various post-transplant time points.
Conclusions:
- Significant echocardiographic abnormalities are common in potential kidney transplant recipients.
- These abnormalities do not appear to affect future kidney graft function.
- Understanding and addressing risk factors for these cardiac conditions may enhance patient outcomes.
Background:
An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients (KTRs). Despite cardiac clearance, potential KTRs still have structural and functional abnormalities. Identifying the prevalence of these abnormalities and understanding their predictors is vital for optimizing pre-transplant risk stratification and improving post-transplant outcomes.
Aim:
To determine the prevalence of left ventricular hypertrophy (LVH), left ventricular systolic dysfunction (LVSD), diastolic dysfunction (DD), pulmonary hypertension (PH), and their predictors, and to assess their impact on graft function in pre-transplant candidates.
Methods:
The study included all successful transplant candidates older than 14 who had a baseline echocardiogram. Binary logistic regression models were constructed to identify factors associated with LVH, LVSD, DD, and PH.
Results:
Out of 259 patients, LVH was present in 64% (166), 12% (31) had LVSD, 27.5% (71) had DD, and 66 (25.5%) had PH. Independent predictors of LVH included male gender [odds ratio (OR): 2.51; 95%CI: 1.17-5.41 P = 0.02], PH (OR = 2.07; 95%CI: 1.11-3.86; P = 0.02), DD (OR: 2.47; 95%CI: 1.29-4.73; P = 0.006), and dyslipidemia (OR = 1.94; 95%CI: 1.07-3.53; P = 0.03). Predictors for LVSD included patients with DD (OR = 3.3, 95% CI: 1.41-7.81; P = 0.006) and a family history of coronary artery disease (OR = 4.50, 95%CI: 1.33-15.20; P = 0.015). Peritoneal dialysis was an independent predictor for DD (OR = 10.03; 95%CI: 1.71-58.94, P = 0.011). The presence of LVH (OR = 3.32, 95%CI: 1.05-10.55, P = 0.04) and mild to moderate or moderate to severe mitral regurgitation (OR = 4.63, 95%CI: 1.45-14.78, P = 0.01) were significant factors associated with PH. These abnormalities had no significant impact on estimated glomerular filtration at discharge, 6 months, 1 year, or 2 years post-transplant.
Conclusion:
Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance, although they don't affect future graft function. Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre- and post-transplant to achieve better outcomes.
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