Changes in echocardiographic indices following kidney transplantation: A systematic review and meta-analysis

Cardiovascular disease is the leading cause of death in end-stage kidney disease and the chronic cardiomyopathy of chronic kidney disease contributes significantly to this. Kidney transplantation (KTx) is associated with improved survival compared to dialysis. This systematic review and meta-analysis (CRD42022371202) aimed to assess the changes in echocardiographic indices in patients before and following KTx.

The literature search involved PubMed, Web-of-Science and Scopus databases, manual search of article references and grey literature. The primary outcome measure was left-ventricular mass index (LVMI).

Thirty-three studies with 2364 patients were included in the metanalysis for the primary outcome. LVMI was significantly decreased after KTx compared to pre-transplantation values [WMD -21.99 g/m², 95 %CI (-28.10, -15.87) I² = 89 %, P < 0.00001]. In subgroup analyses, higher differences were evident among 6 studies (N = 163) evaluating LVMI≤6 months after KTx [WMD -41.54 g/m2, 95 %CI (-51.31, -31.78), I² = 13 %, P < 0.001] and lower differences among 26 studies (N = 2095) evaluating LVMI >6 months after KTx [WMD -18.96 g/m2, 95 %CI (-25.44, -12.47), I2 = 89 %, P < 0.001]. In sensitivity analyses, patients receiving kidney from living kidney donors [(WMD; -76.90 g/m2, 95 %CI (-122.13, -31.67), I2 = 88 %, P < 0.001)] and those on hemodialysis before KTx [WMD;-33.76 g/m2, 95 %CI (-51.51, -16.00), I2 = 92 % P < 0.001] presented higher LVMI reductions following transplantation.

KTx is associated with significant reductions in LVMI compared to the pre-transplantation levels. This could be another factor contributing to the lower cardiovascular risk observed after KTx compared to dialysis.