Effect of Renal Transplantation on Left Ventricular Ejection Fraction in Patients on Dialysis with Ischemic and Nonischemic Cardiomyopathy

• Published in: Clinical transplantation Vol. 39; no. 5; pp. e70176 - n/a
• Main Authors: De Lima, Jose Jayme G., Gowdak, Luis Henrique W., Reusing, José Otto, David‐Neto, Elias, Bortolotto, Luiz A.
• Format: Journal Article
• Language: English
• Published: Denmark 01.05.2025
• Subjects: Adult; Aged; Cardiomyopathies - complications; Cardiomyopathies - mortality; Cardiomyopathies - physiopathology; cardiovascular disease; complication: medical/metabolic; Female; Follow-Up Studies; Glomerular Filtration Rate; heart disease; Humans; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Kidney Transplantation - mortality; Male; Middle Aged; Myocardial Ischemia - complications; Myocardial Ischemia - physiopathology; Prognosis; Renal Dialysis; Retrospective Studies; Risk Factors; Stroke Volume; Survival Rate; Ventricular Function, Left; cardiovascular disease; heart disease; complication: medical/metabolic
• ISSN: 0902-0063; 1399-0012; 1399-0012
• DOI: 10.1111/ctr.70176

ABSTRACT Background Transplant centers exclude patients from the waiting list with reduced left ventricular ejection fraction (LVEF). It is unclear whether renal transplantation (RT) is safe, will have different impacts on patients with ischemic/nonischemic reduced LVEF, and whether myocardial revascularization will influence prognosis. Methods Four hundred and sixty RT patients assessed for coronary artery disease (CAD) and with LVEF determined before and after RT were divided into four groups (Group 1: No CAD and normal LVEF [reference]; Group 2: CAD and normal LVEF; Group 3: No CAD and reduced LVEF [nonischemic cardiomyopathy]; Group 4: CAD and reduced LVEF [ischemic cardiomyopathy]) and followed until death. Results RT was associated with increased LVEF in patients with cardiomyopathy. Patients with ischemic cardiomyopathy had a reduced survival rate; coronary intervention and medical treatment had comparable effects on outcomes. However, LVEF or CAD did not influence outcomes. Conclusions RT can be performed safely in patients with ischemic and nonischemic reduced LVEF and is associated with substantial improvement in LVEF. Although the long‐term outcomes were poorer in patients with ischemic disease, LVEF and CAD were not independent predictors of events or death after adjustments. Therefore, reduced LVEF, even in patients with CAD, should not hamper the indication for RT.