PREOPERATIVE ECHOCARDIOGRAPHIC ABNORMALITIES AND ADVERSE OUTCOME FOLLOWING RENAL-TRANSPLANTATION

Background. Premature cardiovascular disease is now the leading cause of death in renal transplant recipients. Although patients with progre ssive renal disease have many of the conventional risk factors for car diovascular disease these do not have the same predictive power as the y do in the general population. Echocardiographic abnormalities, notab ly left ventricular hypertrophy, have been shown to be associated with adverse outcome in patients on dialysis. Methods. The echocardiograms were studied from 141 patients who were examined on the eve of renal transplantation between 1988 and 1990 to try to identify factors predi cting outcome. Thirty-four patients have since died, 22 of cardiovascu lar disease. Ninety-three of the survivors and 27 of the dead patients had echocardiographic traces suitable for analysis. Results. Left ven tricular mass index was increased in those patients who died (median 1 67 vs 134 g/m(2); P = 0.03), as were end-systolic (4.3 vs 3.4 cm; P < 0.01) and end-diastolic (5.8 vs 5.2 cm; P < 0.01) diameters. Systolic function was also more severely impaired (fractional shortening, 27 vs 33%; P < 0.01). Apart from age, only systolic function and end systol ic diameter were independent predictors of outcome in multivariate ana lysis. Conclusions, This pattern of echocardiographic abnormality is s imilar to that reported in long-term dialysis populations, despite the adverse effects on survival. Moreover, despite potential benefits of transplantation on cardiac function, left ventricular hypertrophy, ven tricular dilatation and systolic dysfunction were all associated with adverse outcome following transplantation. We conclude that echocardio graphy identifies markers for premature death following transplantatio n and provides targets for therapeutic intervention.