LEFT VENTRICULAR HYPERTROPHY AND DIASTOLIC FUNCTION IN PEDIATRIC RENAL TRANSPLANT RECIPIENTS

Abstract

1000 Cardiovascular mortality remains significant in adults after renal transplantation, but little data is available for children with renal grafts. Doppler and M-mode echocardiography were used to investigate left ventricular function and structure in 8 children at a mean of 7 yrs (range 3-11) after renal transplantation (mean age 15 yrs, range 12-18). Seven of 8 patients were on antihypertensive medications. Subjects were compared with 2 age-matched control groups: 21 normotensive children and 37 children with untreated essential hypertension. Kruskall-Wallis analysis of variance demonstrated significant differences among groups for left ventricular mass indexed to height2.7 (LVMIH, p<0.0001), ratio of peak mitral E to A wave velocity (E/A, p=0.0008), peak mitral A wave velocity (A wave, p=0.002), and isovolumic relaxation time (IVRT, p<0.0001). Transplant patients had increased LVMIH (41 g/m2.7) compared to normotensive (25) and hypertensive controls (32). Compared with normotensive controls, transplant patients had decreased E/A (2.0 vs 1.6), increased A wave (44 vs 54 cm/sec) and prolonged IVRT (44 vs 55 ms) whereas transplant patients and hypertensive controls had no significant differences for these measures of diastolic function. Among the 3 groups there were no significant differences for indexed left ventricular diastolic dimension and left ventricular contractility (peak wall stress-mean velocity of circumferential shortening). Transplant patients were shorter than both control groups and had increased body mass index compared to normotensive controls, but had similar body mass index as hypertensive controls. Within the transplant group, echocardiographic variables did not correlate with time since transplant, months on dialysis, creatinine, EGFR, or ambulatory blood pressures. We conclude that left ventricular hypertrophy and impaired ventricular relaxation are present in children many years after renal transplantation. Larger studies are needed to investigate risk factors for ventricular hypertrophy and impaired filling.