Key result
Kidney transplantation is linked to a ~9% LVEF increase in patients with baseline LV dysfunction.
Why the study?
Data were lacking regarding predictors of myocardial recovery following kidney transplantation and their long-term outcomes in patients with cardiac dysfunction.
Does kidney transplantation improve cardiac structure, function, and survival in patients with cardiac dysfunction?
Cohort (n=232)
No
Does kidney transplantation improve cardiac structure, function, and survival in patients with cardiac dysfunction?
Absolute Event Rate: 50% vs 41%
p-value: p=<0.0001
Kidney transplantation is associated with significant reverse cardiac remodeling and improved survival, with post-transplant increases in hemoglobin being a key predictor of these benefits.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“As clinicians who take care of patients with ESRD, mild to moderate cardiac dysfunction should not necessarily be a prohibitive factor to kidney transplantation. Our study suggests that anemia may be the key link to the cardiorenal interaction observed in patients with ESRD.”
LVEF improvement after kidney transplant was associated with survival; leaves open need for prospective trials before changing selection criteria.
BACKGROUND: Cardiac dysfunction influences candidate selection for kidney transplantation. There is a paucity of data regarding predictors of myocardial recovery following kidney transplantation and long-term outcomes. OBJECTIVES: The purpose of this study was to identify the extent of reverse remodeling in our kidney transplant population and the predictors of such changes, and to assess outcomes in these patients. METHODS: We reviewed 232 patients who underwent kidney transplantation at the Cleveland Clinic from 2003 to 2013 and who had baseline and post-transplant echocardiograms; patients with simultaneous heart transplantation were excluded. RESULTS: Post-transplantation mean left ventricular ejection fraction (LVEF) improved in those with LV dysfunction (increased from 41% to 50%; p < 0.0001; n = 66). There was significant improvement in other parameters, including diastolic function, LV end-diastolic dimension, LV mass, and right ventricular systolic pressure. After adjusting for multiple clinical variables, increased hemoglobin following transplantation was associated with an improved LVEF (odds ratio: 1.50; 95% confidence interval [CI]: 1.07 to 2.14; p = 0.016) and reduced mortality (hazard ratio [HR]: 0.65; 95% CI: 0.49 to 0.87; p = 0.004). An improved LVEF ≥10% predicted survival independently of a pre-transplantation LVEF (HR: 0.46; 95% CI: 0.21 to 0.93; p = 0.031). CONCLUSIONS: Kidney transplantation is associated with improved cardiac structure and function. A rise in post-transplantation hemoglobin was a significant factor associated with such changes, in addition to conferring a survival advantage.
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Hawwa et al. (2015) conducted a cohort in Cardiac dysfunction in kidney transplant candidates (n=232). Kidney transplantation vs. Baseline (pre-transplantation) was evaluated on Mean left ventricular ejection fraction (LVEF) in patients with baseline LV dysfunction (p=<0.0001). Kidney transplantation was associated with an improvement in mean LVEF from 41% to 50% in patients with baseline LV dysfunction (p<0.0001).
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