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Published on: April 27, 2019
Cardiac adaptation in pediatric kidney transplant recipients with large donor-recipient size discrepancy: a
Mark W Schaars1,2, Floris E A Udink Ten Cate3, Elisabeth A M Cornelissen4
1Technical Medicine, University of Twente, Enschede, The Netherlands.
Insights
Pediatric kidney transplant recipients with large donor-recipient size mismatch showed improved left ventricular (LV) function and reduced LV mass within one year. These findings suggest beneficial cardiac remodeling despite increased hemodynamic burden.
Area of Science:
- Cardiology
- Pediatric Nephrology
- Transplantation Medicine
Background:
- Pediatric kidney transplantation (KT) with significant donor-recipient size mismatch imposes a hemodynamic burden.
- The impact of large size mismatch KT on cardiac function in children is not well understood.
Purpose of the Study:
- To evaluate left ventricular (LV) function and geometry in pediatric KT recipients with large donor-recipient size mismatch.
- To assess changes using conventional and speckle-tracking echocardiography.
Main Methods:
- Prospective longitudinal study of pediatric KT recipients with large size mismatch.
- Echocardiography (conventional and speckle-tracking) performed pre-KT, early post-KT, and at 6 and 12 months.
- Measured LV global longitudinal strain (GLS), LV ejection fraction, cardiac index, LV mass index (LVMi), and LV dimensions.
Main Results:
- Ten pediatric patients (median age 5.9 years) with a median donor-recipient body surface area ratio of 2.36 were included.
- Pre-transplant LV systolic dysfunction (GLS -18.9%) was present in 80% of patients.
- Significant improvement in GLS (-1.3%) and reduction in LVMi (-14.3 g/m^2.7) observed at 12 months post-KT (p<0.05).
Conclusions:
- Pediatric KT with large size mismatch leads to improved LV function and reduced LV mass within one year.
- These changes indicate reversed cardiac remodeling despite significant hemodynamic challenges.
- Echocardiography is valuable for monitoring cardiac adaptation post-transplantation.
Background:
Pediatric living donor kidney transplantation (KT) with large donor-recipient size mismatch induces a large hemodynamic burden on the child recipient. Although successful KT is known to be beneficial for cardiac function and remodeling, its effects in small recipients with adult donors have not been evaluated. We aimed to describe left ventricular (LV) function and geometry using conventional and speckle-tracking echocardiography in this population.
Methods:
A prospective longitudinal study was performed. Living donor KT recipients with large donor-recipient size mismatch underwent conventional and speckle-tracking echocardiography prior to KT, shortly after KT and at 6 and 12 months post-transplantation. LV global longitudinal strain (GLS), LV ejection fraction, cardiac index, LV mass index (LVMi) and LV dimensions were obtained.
Results:
Ten patients were included with a median [IQR] age of 5.9 years [4.4-8.5]. The median donor-recipient body surface area ratio was 2.36. Prior to transplantation, LV systolic dysfunction was found in 80% of the patients (GLS -18.9% [-19.7--18.7]). Significant improvement was found after 12 months (change in GLS -1.3% [-1.8--0.9], p = 0.004). A significant reduction in LVMi was found at 6 months and 12 months of -8.9 g/m2.7 [-15.6--5.4], p = 0.01 and -14.3 g/m2.7 [-15.3--12.9], p = 0.004, respectively. No significant changes in cardiac index were found at 6 and 12 months.
Conclusions:
Despite the increased hemodynamic demands after pediatric KT with large donor-recipient size mismatch, improved LV function and reduced left ventricular mass were found within 1 year after transplantation. These results suggest reversed cardiac remodeling.
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