Effect of Renal Transplantation on Left Ventricular Ejection Fraction in Patients on Dialysis with Ischemic and Nonischemic Cardiomyopathy

BACKGROUND: Transplant centers exclude patients from the waiting list with reduced left ventricular ejection fraction (LVEF). It is unclear whether renal transplantation (RT) is safe, will have different impacts on patients with ischemic/nonischemic reduced LVEF, and whether myocardial revascularization will influence prognosis. METHODS: Four hundred and sixty RT patients assessed for coronary artery disease (CAD) and with LVEF determined before and after RT were divided into four groups (Group 1: No CAD and normal LVEF [reference]; Group 2: CAD and normal LVEF; Group 3: No CAD and reduced LVEF [nonischemic cardiomyopathy]; Group 4: CAD and reduced LVEF [ischemic cardiomyopathy]) and followed until death. RESULTS: RT was associated with increased LVEF in patients with cardiomyopathy. Patients with ischemic cardiomyopathy had a reduced survival rate; coronary intervention and medical treatment had comparable effects on outcomes. However, LVEF or CAD did not influence outcomes. CONCLUSIONS: RT can be performed safely in patients with ischemic and nonischemic reduced LVEF and is associated with substantial improvement in LVEF. Although the long-term outcomes were poorer in patients with ischemic disease, LVEF and CAD were not independent predictors of events or death after adjustments. Therefore, reduced LVEF, even in patients with CAD, should not hamper the indication for RT.