Changes in Cardiac Structure and Function Before and After Renal Transplantation: A Longitudinal Study

Jhinger, Manpreet Kaur; Sohal, P.M.; Makkar, Vikas; Tondon, Rohit; Wander, Gurpreet Singh; Sandhu, Jeet

doi:10.1016/j.transproceed.2021.01.026

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…The phenomenon is recognized as uremic cardiomyopathy (UC), or the cardiorenal syndrome type 4. Renal transplantation may reverse some of the cardiac abnormalities associated with chronic kidney disease [19][20][21]. Our study demonstrated significant increase in LVEF post-kidney transplant, of more than 5% in 28% of the patients (81/293) and at least 10% LVEF improvement in 12% (36/293) of them.…”

Section: Discussionsupporting

confidence: 48%

Improvement in Echocardiographic Indexes of Systolic Heart Failure Post-Kidney Transplantation: A Retrospective Analysis

Skalsky,

Perl,

Rozen Zvi

et al. 2024

Cardiology

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Introduction: End-stage renal disease (ESRD) is a major risk factor for cardiovascular morbidity and mortality, which can be partially eliminated by kidney transplantation. Systolic heart failure might be considered as contraindication for kidney transplant although some patients demonstrate myocardial recovery post-transplant. We aim to identify and characterize the phenomenon of reverse myocardial remodelling in kidney transplanted patients. Methods: The study is a retrospective cohort of patients undergoing kidney transplant between 2016-2019 (n=604) at Rabin Medical Center. Patients were assessed according to availability of two echocardiographic examinations: pre- and post-kidney transplant. The change in estimated ejection fraction (EF) and possible predictors of myocardial recovery were examined. Results: Data of 293 patients was available for the final analysis. Eighty-one (28%) patients had a LVEF improvement equal or above 5%, whereas 36 (12%) patients had a LVEF improvement 10% or more post transplantation. Twenty-five patients (8.5%) had moderate or severe systolic heart failure with LVEF reduced to 40% or less at baseline. 13 of them (52%) had a LVEF improvement of ≥5% and 10 patients (40%) had an improvement of ≥10% in their EF. Cox regression analyses identified female gender as the only independent variable associated with LVEF improvement of at least 10%. Conclusion Renal transplantation might lead to improved LV systolic function in some patients.

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Section: Discussionsupporting

confidence: 48%

Improvement in Echocardiographic Indexes of Systolic Heart Failure Post-Kidney Transplantation: A Retrospective Analysis

Skalsky,

Perl,

Rozen Zvi

et al. 2024

Cardiology

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“…Initially, 7416 references were identified. Forty-six studies, 16–61 involving 4122 participants with a mean age of 46.2 ± 7.6 y and a mean body mass index of 26.4 ± 10.3 kg/m 2 , met the inclusion criteria. Eleven studies were cross-sectional, and 35 were longitudinal.…”

Section: Resultsmentioning

confidence: 99%

Left Ventricular Hypertrophy After Renal Transplantation: Systematic Review and Meta-analysis

Tian,

Bergmann,

Kaufeld

et al. 2024

Transplantation Direct

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Background. Left ventricular hypertrophy (LVH) in patients with end stage renal disease undergoing renal replacement is linked to an increased risk for cardiovascular diseases. Dialysis does not completely prevent or correct this abnormality, and the evidence for kidney transplantation (KT) varies. This analysis aims to explore the relationship between KT and LVH. Methods. MEDLINE and Scopus were systematically searched in October 2023. All cross-sectional and longitudinal studies that fulfilled our inclusion criteria were included. Outcome was left ventricular mass index (LVMI) changes. We conducted a meta-analysis using a random effects model. Meta-regression was applied to examine the LVMI changes dependent on various covariates. Sensitivity analysis was used to handle outlying or influential studies and address publication bias. Results. From 7416 records, 46 studies met the inclusion criteria with 4122 included participants in total. Longitudinal studies demonstrated an improvement of LVMI after KT −0.44 g/m2 (−0.60 to −0.28). Blood pressure was identified as a predictor of LVMI change. A younger age at the time of KT and well-controlled anemia were also associated with regression of LVH. In studies longitudinally comparing patients on dialysis and renal transplant recipients, no difference was detected −0.09 g/m2 (−0.33 to 0.16). Meta-regression using changes of systolic blood pressure as a covariate showed an association between higher blood pressure and an increase in LVMI, regardless of the modality of renal replacement treatment. Conclusions. In conclusion, our results indicated a potential cardiovascular benefit, defined as the regression of LVH, after KT. This benefit was primarily attributed to improved blood pressure control rather than the transplantation itself.

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“…This is thought to be because of the resolution of hypertension, anemia, and other triggers of adverse LV remodeling. 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

“…This is thought to be because of the resolution of hypertension, anemia, and other triggers of adverse LV remodeling. 4,5 Hypertrophic cardiomyopathy (HCM) is characterized by a LV maximal end-diastolic wall thickness of ≥13-15 mm, depending on the presence of family history or causal genetics and the absence of secondary causes that induce a pressure or volume load on the LV. 6,7 The prevalence of HCM in the United States is estimated to be 1:250-500 adults.…”

Section: Introductionmentioning

confidence: 99%

Left Ventricular Hypertrophy and Hypertrophic Cardiomyopathy in Adult Solid Organ Transplant Recipients

Reza

Feria

Wang

et al. 2021

Transplantation Direct

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Background. Hypertrophic cardiomyopathy (HCM) in pediatric solid organ transplant recipients has been reported in association with use of calcineurin inhibitors. However, data on the incidence and prevalence of HCM in adult posttransplant patients are limited. We sought to describe the clinical characteristics of solid organ transplant recipients who were diagnosed with HCM from 2011 to 2021 at a single center. Methods. Patients who had undergone solid organ transplant and exhibited left ventricular hypertrophy with left ventricular wall thickness ≥13 mm on transthoracic echocardiography were included. Clinical history, pedigree analysis, clinical genetic testing, transthoracic echocardiography, cardiac magnetic resonance imaging, treatment, and follow-up testing results were collected. Categorical variables were described as n (%). Continuous variables were described with medians and interquartile ranges and compared using the Wilcoxon rank-sum and Kruskal-Wallis tests. A 2-sided P < 0.05 was considered statistically significant. Results. Three lung, 5 kidney, and 4 liver transplant recipients from 12 different families were included. Seven patients (58%) did not carry a preexisting diagnosis of hypertension, and none had a history of aortic or subaortic stenosis. A majority of patients exhibited asymmetric septal hypertrophy (67%; medial septal thickness versus left ventricular posterior wall thickness 17 versus 13 mm; P < 0.001) and dynamic left ventricular outflow tract (LVOT) obstruction (58%). All patients were managed long term with calcineurin inhibitors. Clinical genetic testing in 6 patients identified 2 with disease-causing variants in 2 sarcomere genes, myosin binding protein-C and myosin heavy chain 7. Four patients (33%) underwent successful septal reduction therapy for treatment of symptomatic LVOT obstruction. Conclusions. Symptomatic HCM with dynamic LVOT obstruction can develop in solid organ transplant recipients, and genetic testing can identify individuals with sarcomeric HCM. Medical management and septal reduction therapies are treatment options for severe symptomatic disease.

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Changes in Cardiac Structure and Function Before and After Renal Transplantation: A Longitudinal Study

Cited by 6 publications

References 29 publications

Improvement in Echocardiographic Indexes of Systolic Heart Failure Post-Kidney Transplantation: A Retrospective Analysis

Improvement in Echocardiographic Indexes of Systolic Heart Failure Post-Kidney Transplantation: A Retrospective Analysis

Left Ventricular Hypertrophy After Renal Transplantation: Systematic Review and Meta-analysis

Left Ventricular Hypertrophy and Hypertrophic Cardiomyopathy in Adult Solid Organ Transplant Recipients

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