Cardiac consequences of renal transplantation: Changes in left ventricular morphology and function

To characterize changes in left ventricular morphology and function associated with renal transplantation, noninvasive cardiac evaluations were performed in 41 adults at the time of surgery and at follow-up. At the time of transplantation, 36 patients had undergone hemodialysis through a fistula for...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 1988-10, Vol.12 (4), p.915-923
Main Authors: Himelman, Ronald B., Landzberg, Joel S., Simonson, Jay S., Amend, William, Bouchard, Alain, Merz, Robert, Schiller, Nelson B.
Format: Article
Language:English
Subjects:
Adult
Blood Pressure
Diastole
Echocardiography
Electrocardiography
Female
Heart - physiopathology
Heart Ventricles
Humans
Kidney Transplantation
Male
Middle Aged
Myocardium - pathology
Postoperative Complications
Pulmonary Edema - etiology
Stroke Volume
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Summary:To characterize changes in left ventricular morphology and function associated with renal transplantation, noninvasive cardiac evaluations were performed in 41 adults at the time of surgery and at follow-up. At the time of transplantation, 36 patients had undergone hemodialysis through a fistula for 2.3 ± 2.5 years (mean ± SD); their hematocrit level was 26 ± 6% and systolic blood pressure was 151 ± 19 mm Hg. Perioperatively, left ventricular hypertrophy was present in 93% of patients by echocardiography, but in only 37% by electrocardiography. Abnormal left ventricular diastolic function was present in 67% of patients and indicated a high risk for perioperative pulmonary edema. At follow-up (1.5 ± 14 years), mean hematocrit level increased to 39 ± 7%, systolic blood pressure decreased to 132 ± 14 mm Hg and spontaneous closure of the fistula occurred in 13 patients. Left ventricular mass by echocardiography decreased from 237 ± 66 to 182 ± 47 g (p < 0.001), a decrease of 23%. Left ventricular volumes and cardiac index also decreased significantly, reflecting the rapid resolution of a pretransplant high output state. Despite proportionate regression of left ventricular hypertrophy within months of transplantation, diastolic function did not improve. The significant regression of left ventricular hypertrophy that occurs after renal transplantation may help explain the improved cardiovascular survival of patients with a renal transplant over that of patients on long-term dialysis.
ISSN:0735-1097
1558-3597
DOI:10.1016/0735-1097(88)90454-8