Effect of left atrial and ventricular abnormalities on renal transplant recipient outcome—a single-center study

Patel, R. K., Pennington, C., Stevens, K. K., Taylor, A., Gillis, K. , Rutherford, E., Johnston, N., Jardine, A. G. and Mark, P. B. (2014) Effect of left atrial and ventricular abnormalities on renal transplant recipient outcome—a single-center study. Transplantation Research, 3(20), (doi:10.1186/s13737-014-0020-6)

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Abstract

Background: Premature cardiovascular (CV) death is the commonest cause of death in renal transplant recipients. Abnormalities of left ventricular (LV) structure (collectively termed uremic cardiomyopathy) and left atrial (LA) dilation, a marker of fluid status and diastolic function, are risk factors for reduced survival in patients with end stage renal disease (ESRD). In the present analysis, we studied the impact of pre-transplant LA and LV abnormalities on survival after successful renal transplantation (RT).<p></p> Methods: One hundred nineteen renal transplant recipients (first transplant, deceased donors) underwent cardiovascular MRI (CMR) as part of CV screening prior to inclusion on the waiting list. Data regarding transplant function and patient survival after transplantation were collected.<p></p> Results: Median post-transplant follow-up was 4.3 years (interquartile range (IQR) 1.9, 6.2). During the post-transplant period, 13 patients returned to dialysis after graft failure and 23 patients died with a functioning graft. Survival analyses, censoring for patients returning to dialysis, showed that pre-transplant LV hypertrophy and elevated LA volume were significantly associated with reduced survival after transplantation. Multivariate Cox regression analyses demonstrated that longer waiting time, poorer transplant function, presence of LV hypertrophy and higher LA volume on screening CMR and female sex were independent predictors of death in patients with a functioning transplant.<p></p> Conclusions: Presence of LVH and higher LA volume are significant, independent predictors of death in patients who are wait-listed and proceed with renal transplantation.<p></p> METHODS: One hundred nineteen renal transplant recipients (first transplant, deceased donors) underwent cardiovascular MRI (CMR) as part of CV screening prior to inclusion on the waiting list. Data regarding transplant function and patient survival after transplantation were collected.<p></p> RESULTS: Median post-transplant follow-up was 4.3 years (interquartile range (IQR) 1.9, 6.2). During the post-transplant period, 13 patients returned to dialysis after graft failure and 23 patients died with a functioning graft. Survival analyses, censoring for patients returning to dialysis, showed that pre-transplant LV hypertrophy and elevated LA volume were significantly associated with reduced survival after transplantation. Multivariate Cox regression analyses demonstrated that longer waiting time, poorer transplant function, presence of LV hypertrophy and higher LA volume on screening CMR and female sex were independent predictors of death in patients with a functioning transplant.<p></p> CONCLUSIONS: Presence of LVH and higher LA volume are significant, independent predictors of death in patients who are wait-listed and proceed with renal transplantation.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Taylor, Dr Alison and Patel, Dr Rajan and Mark, Dr Patrick and Gillis, Dr Keith and Stevens, Dr Kate and Rutherford, Dr Elaine and Jardine, Professor Alan
Authors: Patel, R. K., Pennington, C., Stevens, K. K., Taylor, A., Gillis, K., Rutherford, E., Johnston, N., Jardine, A. G., and Mark, P. B.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Transplantation Research
Publisher:BioMed Central
ISSN:2047-1440
ISSN (Online):2047-1440
Copyright Holders:Copyright © 2014 The Authors
First Published:First published in Transplantation Research 3:20
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
361621Redefinition of uraemic cardiomyopathy and vascular disease using carotoid and cardiac MRIAlan JardineBritish Heart Foundation (BHF)FS/03/103/16332RI CARDIOVASCULAR & MEDICAL SCIENCES