Early echocardiographic changes and survival following renal transplantation

Background. Left ventricular hypertrophy, ventricular dilatation and poor s ystolic function prior to renal transplantation are associated with increas ed mortality. However, whether the improvement in these echocardiographic i ndices that is reported to follow renal transplantation improves patient su rvival has not been investigated. Methods. We studied 67 patients who underwent renal transplantation in our unit between 1988 and 1990 and in whom echocardiography was performed immed iately prior to transplant surgery and 4 months later. Pre- and post-transp lantation echocardiographic parameters were compared between the 20 patient s who have since died and surviving patients and a descriptive survival ana lysis was performed. Results. Following transplantation there was no significant change in left ventricular mass index (LVMI) or end diastolic diameter (EDD). End systolic diameter (ESD) improved in 60% of patients (median 3.3 vs 3.7 cm; P = 0.03 1) as did fractional shortening in 67% (0.33 vs 0.29; P = 0.001). However, improvement was not associated with survival benefits. We also found that p rior to transplantation, fractional shortening, ESD and EDD were strongly a ssociated with outcome; this was no longer the case following transplantati on. In contrast, LVMI provided a stronger association with adverse outcome (albeit of limited statistical significance) following transplantation. Conclusions. In this Preliminary Report, we conclude that echocardiographic parameters are associated with adverse outcome in patients receiving renal replacement therapy (RRT). Different echocardiographic parameters are asso ciated with adverse outcome before and after renal transplantation and impr ovement of pre-transplant abnormalities (e.g. poor LV systolic function) fo llowing transplantation does not necessarily confer survival benefits. Whet her this is a genuine observation or a reflection of the interpretation of echocardiographic measurements in dialysis patients requires further invest igation.