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August 22, 2026ESC Heart FailureOpen Access

Distinct Prognostic Trajectories of Heart Failure Phenotypes Following Kidney Transplantation

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Why the study?

Heart failure drives post-kidney transplant morbidity, but the persistence of post-transplant risk in HFpEF versus HFrEF remains unclear despite kidney transplantation reversing uremic cardiomyopathy components.

Does pre-transplant heart failure phenotype (HFpEF vs HFrEF) predict distinct prognostic trajectories and post-transplant morbidity in adult kidney transplant recipients?

Population

442 adult kidney transplant recipients

Comparison

HFpEF vs HFrEF vs controls

Design

Retrospective cohort study

Follow-up

Median 49-month

Key result

Pre-transplant HFpEF in kidney transplant recipients was independently associated with an increased risk of heart failure hospitalization (aHR 9.57; 95% CI 3.37-27.2; p<0.001).

Authors

MBMaor BrilAIAshraf ImamEPElchanan Parnasa

Discussion

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Overview

Pre-transplant HFpEF may warrant closer post-kidney transplant surveillance; hypothesis-generating for phenotype-specific trials.

Key Points

  • To evaluate phenotype-specific longitudinal cardiac remodeling and clinical outcomes in kidney transplant recipients with pre-transplant HFpEF versus HFrEF.
  • Retrospective cohort study of 442 adult kidney transplant recipients stratified by pre-transplant echocardiography into HFpEF (N=64, 14.5%), HFrEF (N=44, 10.0%), or controls (N=334, 75.5%).
  • Assessed longitudinal echocardiographic remodeling and clinical outcomes over a median follow-up of 49 months using multivariable Cox regression.
  • Pre-transplant HFpEF was independently associated with heart failure hospitalization (aHR 9.57; 95% CI 3.37–27.2, p < 0.001) and composite death/HF hospitalization (aHR 4.46; 95% CI 2.36–8.42, p < 0.001), accompanied by persistent diastolic stiffness (E/e': 12.7 ± 4.6 to 11.8 ± 5.3, p = 0.117).
  • Pre-transplant HFrEF exhibited significant systolic recovery (ΔLVEF +8.7 ± 10.2%, p = 0.003) and was associated with all-cause mortality (aHR 2.9; 95% CI 1.16–7.25, p = 0.023), but not heart failure hospitalization (aHR 3.11; 95% CI 0.71–13.6, p = 0.13).
  • Improvement in LVEF predicted lower heart failure hospitalization risk (aHR 0.94; 95% CI 0.90–0.99, p = 0.02), while mortality tracked with continuous changes in hemoglobin (aHR 0.71; 95% CI 0.60–0.83, p < 0.001) and calcium (aHR 0.69; 95% CI 0.50–0.96, p = 0.027).

Study Design

Type

Cohort (n=442)

Structured PICO

Does pre-transplant heart failure phenotype (HFpEF vs HFrEF) predict distinct prognostic trajectories and post-transplant morbidity in adult kidney transplant recipients?

P
Population
442 adult kidney transplant recipients, including those with HFpEF, HFrEF, and controls, followed for a median of 49 months.
E
Exposure
Pre-transplant heart failure phenotype (HFpEF or HFrEF)
C
Comparator
Controls (kidney transplant recipients without heart failure)
O
Outcome
Heart failure hospitalization and composite death/HF hospitalizationcomposite

Main Result

Hazard Ratio: 9.57 (95% CI 3.37–27.2)

p-value: p=< 0.001

Pre-transplant HFpEF in kidney transplant recipients is a persistent phenotype driving severe post-transplant morbidity, whereas HFrEF demonstrates systolic reversibility.

Cite This Study

Bril et al. (2026) conducted a cohort in Heart failure following kidney transplantation (n=442). Pre-transplant heart failure with preserved ejection fraction (HFpEF) vs. Controls was evaluated on Heart failure hospitalization (aHR 9.57, 95% CI 3.37-27.2, p=< 0.001). Pre-transplant HFpEF in kidney transplant recipients was independently associated with an increased risk of heart failure hospitalization (aHR 9.57; 95% CI 3.37-27.2; p<0.001).

synapsesocial.com/papers/6a89600eca7ade938187f083https://doi.org/10.1093/eschf/xvag221
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