Improvement of Cardiac Functions After Renal Transplantation in Patients with Severe Cardiac Risk

Abstract

Introduction Chronic kidney disease (CKD) has increased risk for cardiovascular morbidity and mortality. CKD evokes structural and functional cardiac changes such as left ventricular hypertrophy (LVH), LV dilatation, LV systolic and diastolic dysfunction. Increased blood pressure, volume overload and in particular the uremic milieu with its toxins contribute to these alterations. Restoration of renal function after renal transplantation (RT) disrupts the negative cardiorenal interplay and may reverse some of the cardiac changes seen with CKD. The surgical procedure is risky in these patients but RTX reduces cardiac mortality and the risk for development of chronic heart failure compared with long-term dialysis. We presented the patients with high cardiovascular risk and the success of renal transplantation on the cardiac functions. Materials and Methods Thirteen RT patients who had severe cardiac risk were evaluated by echocardiography before and after RT. Left ventricular diastolic diameter, systolic diameter, and ejection fraction (%) were assessed by echocardiographic standard parameters. Results Mean transplantation age was 12.4±4.2 years and mean follow-up period 28.2±15.3months after transplantation of thirteen patients (F/M:7/6). There was a statistically significant improvement (p<.01) in all cardiac parameters. Preoperative mean ejection fraction (EF) significantly increased after RT within six months (34.4±9.1%, 68.4±7.6% respectively, p<.01). Preoperative mean left ventricular diastolic diameter (LVDD) and mean systolic diameter (SD) were significantly decreased, after RT within six months (53.8±8.8 vs 40.6±8.5 and 44.7±8.6, vs 25.5±7.4 respectively, p<.01). There were 11 patients (90.9%) received multiple antihypertensive treatment before transplantation. Only 2 patients (15.3%) needed antihypertensive treatment after transplantation. After RT, serum creatinine level was 0.56±0.11 (0.5-1.06) mg/dl and glomerular filtration rate was 102.38±23.29 (51-126) ml/min/1.73 m2 in the sixth month. Conclusions Cardiac functions improve markedly and rapidly in ESRD patients with severe cardiac risk after renal transplantation. We suggest that although the surgical procedure is risky, RT should be considered the treatment of choice for these patients, because longer duration of dialysis in these patients may result in progressive and ultimately irreversible myocardial dysfunction.