The Effect of Kidney Transplant on Cardiac Function: An Echocardiographic Perspective

Abstract

Kidney transplant (KT) resolves many of the cardiac abnormalities associated with chronic kidney failure (CKF). This study analyzed cardiac alterations of kidney failure and their modification with transplant. Thirteen patients in CKF underwent conventional echocardiograms, dobutamine stress echocardiograms, and injection of contrast to examine perfusion before KT and 3 months after transplant. Nine patients had evidence of left ventricular hypertrophy and six had evidence of diastolic dysfunction. Wall thickness, left ventricular mass, and mass index diminished after KT; only two patients continued to manifest hypertrophy. Left ventricular systolic diameters and volumes diminished at 3 months, and diastolic diameters after 4 months. Left ventricular fractional shortening and ejection fraction increased 3 months after transplant. At the end of the study, only two patients continued to show diastolic dysfunction. Dobutamine echocardiograms showed no segmental wall-movement abnormalities. Myocardial perfusion was normal before and after transplant. The results suggest that KT diminishes hypertrophy and improves left ventricular systolic and diastolic function. Echocardiography provides valuable information for detection and follow-up of cardiac abnormalities in patients with kidney disease. Evaluation of segmental wall movement and myocardial perfusion aid in demonstrating that our studied patients with CKF had no indirect signs of coronary artery disease.

Improved Left Ventricular Structure and Function After Successful Kidney Transplantation

“…In accordance with previous studies [5,22,24,25], we were able to show that restoration of renal function by KTX ameliorated blood pressure control after KTX and significantly reversed LVH. Of note, all of the investigated 31 kidney transplant recipients in the present study were successfully transplanted (defined as the absence of maintenance dialysis since the date of KTX and a significant improvement of GFR).…”

“…However, LV longitudinal function as assessed by STE (GLPS) improved significantly after KTX. Again, reasons for the improvement of LV function after KTX are multifactorial and complementary including the removal of uremic toxins, reversal of LVH, hemodynamic changes and restoration of inflammation [2,24,26,29]. We observed that patients with higher systolic blood pressure before KTX benefit the most from transplantation in terms of improvement of GLPS.…”

Impact of Left Ventricular Dysfunction on Renal Transplant Survival: Study of Paired Kidneys From the Same Donor

“…The most frequent causes of HF are from left ventricular systolic dysfunction (LVSD), frequently evaluated by ejection fraction or left ventricular diastolic dysfunction. Although it has been reported that patients with low pretransplantation left ventricular ejection fraction (LVEF) may become normalized during the first year of evolution and that cardiac mortality decreases in them [4,5], our clinical experience with these patients does not agree with these results. Even in recent years, it has been described that dialysis may be an effective way to treat patients with LVSD [6].…”

Systolic Dysfunction Portends Increased Mortality among Those Waiting for Renal Transplant

“…Second, it identifies a subset of the CKD population (those with SD, with or without ischemia) at significantly higher mortality risk while awaiting transplantation, where the role of medical interventions and devices such as implantable cardiac defibrillators and pacemakers should be studied. Transplantation is considered the therapy of choice for advanced stages of CKD, and improvements or even normalization of LV function within the first year of engraftment have been described 14,15 ; however, because of disparities in the supply of organs and number of listed patients, transplantation is often delayed for months or years, which results in unacceptably high mortality rates in individuals waiting for a kidney. Because the Centers for Medicare and Medicaid Services and the United Network for Organ Sharing are currently evaluating kidney allocation policies in the light of "net benefit," 16 the significance of LV function in influencing outcomes should be studied prospectively.…”