Impact of Pre-Existing Left Ventricular Dysfunction on Kidney Transplantation Outcomes: Implications for Patient Selection

Significant benefits after renal transplantation in patients with chronic heart failure and chronic kidney disease

“…Patients with low EF should not be excluded from transplantation, given favorable outcomes. 14 CKD is an independent cardiovascular risk state. Ejection fraction declined during the transition period from advanced CKD to ESRD.…”

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

“…The 3‐year survival rate of patients on dialysis after diagnosis of CHF is reported as only 17% 77, 92. Moreover, the median survival of patients with systolic dysfunction is 38 months compared with 66 months in patients with normal systolic function 92.…”

“…KDOQI guidelines recommend that patients should be evaluated with an echocardiogram at the initiation of dialysis once dry weight is achieved, ideally 1 to 3 months after the initiation of dialysis, and at 3‐year intervals thereafter24 to assess LVEF, structural abnormalities, and valvular disease 20. Although many studies have demonstrated that patients with low LVEF can safely undergo renal transplantation7, 92, 96—most notably, a report of 11 patients with LVEF ≤20%7—there is currently no consensus regarding the minimum LVEF required to safely undergo renal transplantation.…”

“…The 3-year survival rate of patients on dialysis after diagnosis of CHF is reported as only 17%. 77,92 Moreover, the median survival of patients with systolic dysfunction is 38 months compared with 66 months in patients with normal systolic function. 92 In a study of nearly 3700 patients with ESRD, LVEF was the best predictor of mortality, with a 2.7% morality increase for each 1% decrease in LVEF for patients awaiting renal transplantation.…”

“…77,92 Moreover, the median survival of patients with systolic dysfunction is 38 months compared with 66 months in patients with normal systolic function. 92 In a study of nearly 3700 patients with ESRD, LVEF was the best predictor of mortality, with a 2.7% morality increase for each 1% decrease in LVEF for patients awaiting renal transplantation. 93 Similarly, a study of >60 000 patients with renal transplantation found that although there was a modest risk of cardiovascular mortality early in the postoperative period, the cardiac death rate dropped significantly 3 months after transplantation compared with patients who remained on the waiting list.…”