Pre-Transplant Left Atrial Volume Index and One-Year Morbidity After Kidney Transplantation

Pre-transplant echocardiography is routinely performed in kidney transplant candidates, although it remains unclear which parameters are associated with the broad spectrum of post-transplant complications beyond cardiovascular events. Left atrial volume index (LAVI) reflects chronic diastolic burden, and its relationship with overall post-transplant morbidity has not been well defined.

In a single-center retrospective cohort of 242 adults undergoing first kidney-only transplantation (2020 to 2022) with pre-transplant echocardiography within 12 months, the main outcome was a composite of one-year post-transplant complications. Multivariable logistic regression was adjusted for age, sex, BMI, diabetes, and deceased donor status.

LAVI was abnormal (>34 mL/m²) in 83 of 218 patients (38.1%), with largely preserved systolic function (mean LVEF 59.1 ± 6.2%). Abnormal LAVI was associated with the composite outcome (69.5% versus 53.2%, adjusted OR 2.01, 95% CI 1.08 to 3.73, p = 0.027), with a graded increase across tertiles (trend p = 0.030). No individual complication category reached significance. Excluding cardiac events, the non-cardiac composite was similar in magnitude but not conventionally significant (adjusted OR 1.80, 95% CI 0.98 to 3.32). No other echocardiographic parameter was associated with the outcomes. Atrial fibrillation analyses were exploratory and should be interpreted cautiously.

Pre-transplant LAVI >34 mL/m² was associated with a higher burden of one-year post-transplant morbidity, with a graded relationship across severity. No individual complication category reached significance. These findings are hypothesis-generating and require prospective validation before clinical use.