Introduction: Cardiac structural and functional abnormalities are common in patients with end-stage renal disease. In these patients, diastolic dysfunction is an independent predictor of cardiovascular events. The impact of pre-renal transplant diastolic dysfunction on the risk of major adverse cardiac events (MACE) after renal transplantation is unknown.
Hypothesis: pre-transplant diastolic dysfunction predicts increased post-renal transplantation MACE risk.
Methods: In a retrospective cohort of consecutive renal transplant recipients, transthoracic echocardiographic reports were reviewed for the presence and grade of diastolic dysfunction. Clinical risk was assessed using the sum of risk factors (range 0 - 8) set-forth by the AHA/ACCF consensus statement on assessment of kidney transplant candidates. These include: age > 60 y, hypertension, diabetes, dyslipidemia, smoking, known cardiovascular disease, dialysis > 1 y and left ventricular hypertrophy. Patients were followed post-transplant for MACE (cardiac death or myocardial infarction). Kaplan-Meier plots, log-rank test and cox-regression models were used in outcome analyses.
Results: Among 234 patients analyzed (39.7% females, mean age 53.3 ± 11.8 y), 136 (71 %) had at least grade 1 diastolic dysfunction. During a mean follow up of 2.9 ± 1.9 y after kidney transplant, a total of 56 MACEs were observed. There was a stepwise increase in MACE risk with worsening diastolic dysfunction (Fig. 1A). Patients with grade 2 or 3 diastolic dysfunction had higher MACE rate [11/30 (36.7%) than those with no or grade 1 diastolic dysfunction [45/204 (22.1%)], P = 0.021 (Fig. 1B). The difference in MACE risk remained significant after adjusting for the sum of AHA risk factors, abnormal myocardial perfusion imaging and left ventricular ejection fraction.
Conclusion: The presence of at least grade 2 pre-transplant diastolic dysfunction is an independent predictor of increased risk of post-renal transplant MACE.