Regression of asymptomatic cardiomyopathy and clinical outcome of renal transplant recipients: a long-term prospective cohort study

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2016-07, Vol.31 (7), p.1168-1174
• Main Authors: Paoletti, Ernesto, Bellino, Diego, Signori, Alessio, Pieracci, Laura, Marsano, Luigina, Russo, Rodolfo, Massarino, Fabio, Ravera, Maura, Fontana, Iris, Carta, Annalisa, Cassottana, Paolo, Garibotto, Giacomo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Disease Progression; Disease-Free Survival; Female; Heart Ventricles - pathology; Humans; Hypertrophy, Left Ventricular - mortality; Hypertrophy, Left Ventricular - pathology; Incidence; Kaplan-Meier Estimate; Kidney Transplantation; Male; Middle Aged; Proportional Hazards Models; Prospective Studies; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - pathology; Renal Insufficiency, Chronic - surgery; Survival Rate; Transplant Recipients; Treatment Outcome
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfv354

Asymptomatic left ventricular hypertrophy (LVH) is highly prevalent and associated with an adverse outcome in renal transplant recipients (RTRs). Nonetheless, there are currently no available studies analyzing the effect of LVH regression on solid clinical endpoints in these patients. This study is the prospective observational extension of two randomized controlled trials aimed at assessing the effect of active intervention on post-transplant LVH in RTRs. We evaluated the incidence of a composite of death and any cardiovascular (CV) or renal event in 60 RTRs in whom LVH regression was observed and in 40 whose LVH remained unchanged or worsened. During an 8.4 ± 3.5-year follow-up, 8 deaths, 18 CV events and 6 renal events occurred in the entire cohort. Multivariable analysis showed that age [hazard ratio (HR) 1.07, 95% confidence interval (CI) 1.03-1.12 each 1 year, P = 0.002] and LVH regression (HR 0.42, 95% CI 0.22-0.87, P = 0.019) were significant predictors of the composite endpoint. Kaplan-Meier estimates showed better survival rates in patients in whom actual LVH regression was achieved (P < 0.001, log-rank test). Age (HR 1.09, 95% CI 1.03-1.15 each 1 year, P = 0.004), better graft function (HR 0.95, 95% CI 0.91-0.99 each 1 mL/min/1.73 m(2) increase in estimated glomerular filtration rate, P = 0.03) and LVH regression (HR 0.41, 95% CI 0.22-0.79, P = 0.01) were significant predictors of the CV endpoint. Patients with a left ventricular mass index decrease also showed better cardiac event-free survival (P = 0.0022, log-rank test). This is the first study to demonstrate that LVH regression, regardless of the therapeutic strategy adopted to achieve it, portends better long-term clinical outcome in RTRs.