Echocardiography-based score to predict outcome after renal transplantation

• Published in: Heart (British Cardiac Society) Vol. 93; no. 4; pp. 464 - 469
• Main Authors: Sharma, Rajan, Chemla, Eric, Tome, Maite, Mehta, Rajnikant L, Gregson, Helen, Brecker, Stephen J D, Chang, Rene, Pellerin, Denis
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.04.2007; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adult; Age; Aged; Biological and medical sciences; Calcification; Cardiac Imaging and Non-Invasive Testing; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular system; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary vessels; Echocardiography - standards; Female; Health risk assessment; Heart attacks; Heart Failure - etiology; Heart Failure - mortality; Humans; Hypertension; Investigative techniques, diagnostic techniques (general aspects); Kidney diseases; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - surgery; Kidney Transplantation - diagnostic imaging; Kidney Transplantation - mortality; left ventricular ejection fraction; left ventricular end-systolic diameter; LVEF; LVESD; Male; Medical imaging; Medical prognosis; Medical sciences; Middle Aged; Mortality; Observer Variation; Patient Selection; Patients; Peripheral Vascular Diseases - complications; Peripheral Vascular Diseases - diagnosis; Peritoneal dialysis; Population; Predictive Value of Tests; Prospective Studies; Risk Assessment; Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Transplants & implants; Treatment Outcome; Ultrasonic investigative techniques; Variables; Sonography; Echocardiography; Prognosis; Prediction; Homotransplantation; Phlebology; Kidney; Treatment; Surgery; Graft; Evolution; Circulatory system; Cardiology; Kidney transplantation
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2006.096826

Background: Given the high cardiac mortality of renal transplant recipients, identification of high-risk patients is important to offer appropriate treatment before transplantation. Aim: To determine patients with high mortality after renal transplantation despite selection according to current criteria. Methods: Preoperative parameters were collected from 203 renal transplant recipients over a follow-up time of 3.6 (1.9) years. The primary end point was all-cause mortality. Results: 22 deaths (11%) and 12 cardiac failures (6%) were observed. Non-survivors were older (p⩽0.001), had larger left ventricular end-systolic diameter (LVSD) (p⩽0.001) and end-diastolic diameter (p = 0.002), and lower ejection fraction (p⩽0.001). Left ventricular mass index (p = 0.001), maximal wall thickness (p = 0.006) and the proportion with mitral annular calcification (p = 0.001) were significantly higher in the non-survivors. The risk factors for ischaemic heart disease and exercise test data were not significantly different between the two groups. Four independent predictors of mortality after renal transplantation were identified: age ⩾50 years (p = 0.002), LVESD ⩾3.5 cm (p = 0.002), maximal wall thickness ⩾1.4 cm (p = 0.014) and mitral annular calcification (p = 0.036). The 5-year survival estimates for 0, 1, 2 and 3 prognostic factors were 96%, 86%, 69% and 38%, respectively. No patient had four prognostic factors. In patients ⩾50 years, the 5-year survival estimates for 0, 1 and 2 additional prognostic factors were 73%, 45% and 18%, respectively. Conclusion: In addition to selection according to current guidelines, age and three conventional echocardiography parameters may further improve risk stratification before renal transplantation.