Clinical profiles and echocardiographic changes of cardiac remodeling among kidney transplant patients

Background/Introduction Cardiac remodeling and dysfunction underlies the increased risk of sudden cardiac death and heart failure in those with CKD. While those with more severe dysfunction have higher risk, kidney transplantation (KTX) shows promise in mitigating adverse cardiac remodeling. Purpose This study aims to explore the relationship between KTX and LV geometry, systolic function, diastolic function, and pulmonary pressures as seen on transthoracic echo (2DE), as well as determine if time spent on dialysis and age at the time of transplant have a significant effect on cardiac remodeling. Methods All patients 19 years and older who underwent KTX from 2010 to 2022 were included in a retrospective cohort study to assess changes in LV geometry and systolic function before and after transplant. Paired t-tests were used to assess LV geometry changes, and Chi-square analysis compared diastolic function and cardiac remodeling. Correlation between age at the time of KTX and time on dialysis were compared using Spearman’s rho. Results Sixty-nine patients included in the study had a mean age 52 (21-77y); 71% were men, mean dialysis duration was 15.54 months (1-71m), and 20.1% underwent preemptive KTX. Fifty-one (73.9%) were hypertensive and 42 were diabetic (60.8%). DKD was the most common CKD etiology (n = 25, 36.2%), followed by HNS 24 (34.7%), and CGN in 16 (23.2%). Pre-KTX 2DE occurred at a median of 4 months (0.03-22m) while post-KTX 2DE was at 30 (4-107m). LV mass index (LVMI) decreased post-KTX, (87.11 from 109.76, p < 0.0001), but there was a trend towards increased relative wall thickness (RWT) (0.46 from 0.43, p = 0.064). This resulted in more patients with concentric remodeling in the post-KTX group (post-KTX 33.3% vs pre- 11.6%, p < 0.002), but those with concentric hypertrophy (17.4% vs 33.3%, p < 0.0320) and eccentric hypertrophy (0% vs 15.9%, p < 0.0005) decreased. Only age at the time of transplant and post-KTX LVMI (rs = 0.30857, p = 0.00989) but not post-KTX RWT: rs = 0.10948, p = 0.37052) were correlated. In addition, younger age at the time of transplant was seen with greater reduction in LVMI, (rs = -0.24793, p = 0.03997), but this was not seen in RWT (rs = -0.0893, p = 0.46559). No significant correlation was seen with LVMI, RWT and time spent on dialysis. There was improvement in diastolic dysfunction (χ2 = 21.51, p = 0.001), seen especially among those with moderate (pre-KTX 17.3% vs post-KTX 5.8%, p = 0.03) and severe dysfunction (5.8% vs 0%, p = 0.04). The rest of the echo parameters including LVEF, LVEDD, LA size, TR jet and PASP all improved significantly after KTX. Conclusion Patients who undergo KTX show improvements in LV mass, size, systolic function, diastolic function, pulmonary pressures, and positive remodeling of baseline concentric and eccentric hypertrophy, however the impact of age on concentric remodeling persists.