Changes in left ventricular structure and function associated with renal transplantation: a systematic review and meta‐analysis

Abstract

Aims This study aimed to examine if the cardiac changes associated with uraemic cardiomyopathy are reversed by renal transplantation. Methods and results MEDLINE, Embase, OpenGrey, and the Cochrane Library databases were searched from 1950 to March 2020. The primary outcome measure was left ventricular mass index. Secondary outcome measures included left ventricular dimensions and measures of diastolic and systolic function. Studies were included if they used any imaging modality both before and after successful renal transplantation. Data were analysed through meta-analysis approaches. Weight of evidence was assessed through the Grading of Recommendations Assessment, Development and Evaluation system. Twenty-three studies used echocardiography, and three used cardiac magnetic resonance imaging as their imaging modality. The methodological quality of the evidence was generally poor. Four studies followed up control groups, two using cardiac magnetic resonance imaging and two using echocardiography. Meta-analysis of these studies indicated that there was no difference in left ventricular mass index between groups following transplantation {standardized mean difference À0.07 [95% confidence interval (CI) À0.41 to 0.26]; P = 0.67}. There was also no difference observed in left ventricular ejection fraction [mean difference 0.39% (95% CI À4.09% to 4.87%); P = 0.86] or left ventricular end-diastolic volume [standardized mean difference À0.24 (95% CI À0.94 to 0.45); P = 0.49]. Inconsistent reporting of changes in diastolic dysfunction did not allow for any meaningful analysis or interpretation. Conclusions The evidence does not support the notion that uraemic cardiomyopathy is reversible by renal transplantation. However, the evidence is limited by methodological weaknesses, which should be considered when interpreting these findings.

New Approaches to Cardiovascular Disease and Its Management in Kidney Transplant Recipients

“…In the study, there were no perioperative deaths, and close to 70% of the patients achieved LVEF >50% at 12 mo posttransplant 188 ; however, a recent meta-analysis on the same topic showed no improvement in LVEF after kidney transplant. 189 In the end, it remains difficult to predict who may benefit from kidney transplant alone and who requires simultaneous heart-kidney transplant.…”

Effect and correlation of patent vascular access flow on left ventricular hypertrophy in kidney transplant patients

“… [16] , however, reported that the prevelance of LVH modestly decreased from 51.2% to 50% after 1 year of KT in which about 30% of patients with LVH prior to transplantation had LVH regression after transplantation while 30% of patients had a new onset of LVH after transplantation, similar with the current study in that the prevalence of LVH non-significantly changed from 39% to 39.6% after the 2 year follow-up in which patients with a new onset LVH and LVH regression were equal at about 10.8%. The current meta -analysis also demontrated no improvement of left ventricular structure and function after KT [18] . In addition to graft function, hypertension and anemia associated with post-KT LVH, mode of dialysis treatment before transplantation, a history of acute allograft rejection, and patent VA were also related [11] .…”

“…CKD patients had multiple risk factors for LVH including traditional risk factors e.g., age, comorbid diseases, ischemic heart disease, and CKD related risk factors e.g.,volume overload, anemia, malnutrition, uremia [13] . Reported prevalences of LVH assessed by echocardigram in KT recipeints varied from 33 to 67% that might be related with a difference in modes of dialysis before KT and post-transplant duration [14] , [15] , [16] , [17] , [18] , in this study the prevalence of LVH was 39% during the mean 3.45 years of post-KT duration. Previous studies found that KT can improve these risk factors and result in a decrease of LVH prevelence from 67 to 75% in pre-transplant to 37–52.1% in 1 year post-transplant patients and the regression of LVH was related with a reduction of serum Cr and improvement of BP control and anemia [14] , [15] .…”

Comparison of left ventricular subclinical systolic dysfunction between hemodialysis patients and renal transplant recipients using real time three‐dimensional echocardiography

“…The development of heart failure is a clinically silent process and it is often diagnosed late during disease progression; therefore, early diagnose is a critical issue. If we identify the at‐risk population during early‐stage we may prevent or delay progression of cardiac dysfunction 31 . We also found a moderate and significant positive correlation between SDI values and elapsed time from the first hemodialysis in hemodialysis group (Figure 4).…”