P3.660: Changes in left ventricular geometry and function after kidney transplantation.

Introduction: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in kidney transplant recipients despite improved graft survival. Left ventricular hypertrophy (LVH) and abnormal left ventricular (LV) geometry are highly prevalent in end-stage kidney disease and are associated with adverse outcomes. Although kidney transplantation (KT) can improve cardiac structure and function, the determinants of changes in LV geometry remain unclear. This study aimed to evaluate changes in LV geometry one year after KT and to identify pre-transplant factors associated with favorable remodeling. Methods: This single-center retrospective study included 108 adult patients who underwent KT between 2016 and 2019, maintained graft function at 1 year, and had transthoracic echocardiography performed both pre-transplant and at 1 year post-KT. LV mass index (LVMI) and relative wall thickness (RWT) were used to classify LV geometry into normal geometry (NG), concentric remodeling (CR), eccentric hypertrophy (EH), and concentric hypertrophy (CH). The primary outcome was change in LV geometry at 1 year. Secondary outcomes included echocardiographic parameters such as left ventricular ejection fraction (LVEF), stroke volume (SV), left atrial volume index (LAVI), E/A ratio, and E/e′ ratio. Multivariable logistic regression analysis was performed to identify factors associated with NG at 1 year. Results: The mean age was 46.4 ± 14.4 years, and 63 patients (58.3%) were male. Preemptive KT was performed in 57 patients (52.8%). The prevalence of hypertension, diabetes mellitus, dyslipidemia, and atherosclerotic CVD was 90.6%, 29.1%, 50.1%, and 11.8%, respectively. Mean eGFR at 1 year was 48.4 ± 15.0 mL/min/1.73 m 2 . LVMI decreased from 113.3 to 98.2 g/m 2 (p < 0.001), and LVH prevalence declined from 51.4% to 27.6% (p = 0.025). LV geometry distribution changed (pre-/post-KT): NG 21.9%/29.2%, CR 26.7%/43.4%, EH 9.5%/8.5%, and CH 41.9%/18.9%. Among patients with NG at 1 year (n = 31), higher pre-transplant intact parathyroid hormone (iPTH) (OR 1.06, 95% CI 1.04–1.10, p < 0.001) and LDL cholesterol (OR 1.04, 95% CI 1.01–1.06, p = 0.002) were independently associated factors. In patients without persistent NG (n = 97), iPTH (OR 1.03, 95% CI 1.00–1.06, p = 0.037) and lower pre-transplant LVMI (OR 0.98, 95% CI 0.96–0.99, p = 0.036) were associated with normalization to NG. LVEF improved from 62.8% to 64.9% (p < 0.001), whereas SV decreased from 75.1 to 70.0 mL (p = 0.01). LAVI decreased from 33.3 to 30.1 mL/m 2 (p = 0.01), and E/e′ improved from 11.2 to 9.7 (p < 0.001), while E/A ratio showed no significant change. Conclusion: KT was associated with regression of LVH and favorable changes in LV geometry at 1 year. Elevated pre-transplant iPTH and LDL cholesterol were independently associated with post-transplant LV geometry, suggesting a role of mineral-bone disorder and metabolic factors in cardiac remodeling.