P3.601: Cardiac structural and functional recovery after renal transplantation: A prospective echocardiographic study of 250 patients from India.

Introduction: Cardiovascular disease is the leading cause of mortality in end-stage renal disease (ESRD). Left ventricular hypertrophy, diastolic dysfunction and systolic impairment are the dominant cardiac manifestations of ESRD, driven by volume overload, hypertension, anaemia and uraemic toxins. Renal transplantation (KT) is expected to reverse these changes by correcting the underlying haemodynamic and metabolic drivers, yet large prospective echocardiographic data from India are lacking. Methods: Prospective observational study of 250 consecutive KT recipients at a tertiary referral centre in Rajasthan, India. Comprehensive 2D echocardiography was performed pre-transplant and at 6 months post-KT. Parameters included LV mass, LVEF, E/A ratio, E/E prime, IVS thickness, LA size and pericardial effusion. Paired t-tests and McNemar’s test were used for statistical comparisons. Results: Mean age 38.8±11.3 years; 80.4% male; 87.6% on haemodialysis pre-KT. At 6 months, all parameters improved significantly (all p<0.001): LV mass fell 16.5% (237.5 to 198.3 g); LVEF improved from 56.8% to 59.6%; E/A normalised (0.92 to 1.08); E/E prime fell from 13.64 to 10.92; diastolic dysfunction prevalence halved from 58.8% to 27.6%; pericardial effusion resolved in 66.7% of affected patients. Serum creatinine fell from 8.13 to 1.29 mg/dL confirming successful graft function. In a post-hoc exploratory analysis, dialysis access type predicted recovery magnitude: tunnelled catheter patients (n=20) showed the greatest improvement — 19.8% LV mass reduction and diastolic dysfunction resolution from 70% to 5% — while AVF patients showed the smallest gains, consistent with persistent high-output fistula loading post-KT (AVF vs DLC: delta E/E prime -1.71 vs -3.44; p=0.044). Duration of pre-transplant dialysis did not independently predict cardiac recovery (r=0.069, p=0.31). Conclusion: Successful KT produces comprehensive cardiac structural and functional recovery within 6 months — the largest prospective echocardiographic dataset from India to date. The null effect of dialysis duration is reassuring and supports early transplantation. The post-hoc access-type finding is hypothesis-generating and warrants prospective evaluation.