P0295improved Left Ventricular Function Evaluation After Kidney Transplant

Abstract

Background and Aims Chronic kidney disease (CKD) represents a major risk factor for cardiovascular (CV) disease. CKD pro inflammatory state evokes structural and functional cardiac and vascular changes, such as chronic dysregulation of nitric oxide in vascular muscle, results in left ventricular hypertrophy (LVH), LV dilatation, LV systolic and diastolic dysfunction, endothelial dysfunction and atherosclerosis. Recent advances in echocardiographic methods allows to evaluate changes in cardiac structure and function after KT. The aim of this study was to assess changes in LV structure and function after renal transplantation in patients with end-stage renal disease (ESRD). Method All subjects were prospectively recruited prior to kidney transplantation in our center at Centro Medico Nacional de Occidente, Jalisco, Mexico. Demographics, echocardiographic evaluation, clinical and biochemical studies were performed before and after KT. Patients with transplant failure after KT were excluded. Thirty patients were included in the final analysis. Statistical analysis: Results are expressed as means and standard deviation (SD). Accordingly, paired T test or Wilcoxon test were used for comparison of paired observations. Categorical variables were compared using chi-square test or Fisher’s exact probability test, as appropriate. Multivariate logistic regression models including the variables changes in LVEF, LV systolic and diastolic function and LV mass index. Statistical analyses were performed using SPSS v26.0 (IBM Corporation, NY, USA); p < 0.05 was considered statistically significant. Results Mean age was 31.99 ± 11.28 years, and 65% were women. Before transplant, LVEF was 58% and pulmonary arterial pressure was 32 mmHg. Ventricular dysfunction was associated with unclamping donor renal vessels at 107.8 ± 7.96mmHg, and lower perioperative hemodynamics values. The LVEF group increased from 25% to 72.5%, and serum creatinine decrease from 2.25 ± 3.76 mg/dl to 1.98± 2.65 mg/dl (p<0.001) by 6 months after kidney transplant. The best set of predictors in multiple regression analysis of renal function were the onset of diuresis and the use of diuretics (R2 = 0.4; p < 0.001). Conclusion We observed a significant reversal of LV dysfunction. This was accompanied by a significant improvement on kidney graft function. These findings highlight the dynamics between cardiac and renal function, and support the application of adequate echocardiographic evaluation on CKD patients with low LVEF undergoing KT.