title: Improvement of cardiac sympathetic innervation by renal transplantation.
abstract: Chronic renal failure (CRF) patients on dialysis frequently show reduced heart rate variability (HRV), which has been reported to be corrected by renal transplantation. Recently, (123)I-metaiodobenzylguanidine ((123)I-MIBG) scintigraphy has been used to evaluate cardiac sympathetic innervation, and uremic patients often show marked abnormalities of cardiac (123)I-MIBG uptake. We investigated whether renal transplantation can improve cardiac (123)I-MIBG uptake in patients with CRF on dialysis.
  
  
  METHODS
  We analyzed time- and frequency-domain measures of 24-h HRV and cardiac (123)I-MIBG scintigraphy before and 1-3 mo after renal transplantation in 13 CRF patients on dialysis and in 10 control subjects.
  
  
  RESULTS
  Both 24-h HRV and cardiac (123)I-MIBG uptake were significantly abnormal in the patients before transplantation compared with the control subjects. After transplantation, (123)I-MIBG washout rate from the myocardium significantly decreased from 46% +/- 21% to 20% +/- 22% (P = 0.006), and the heart-to-mediastinum ratio of (123)I-MIBG uptake in the late image significantly increased from 1.74 +/- 0.39 to 2.06 +/- 0.39 (P = 0.006). On the other hand, HRV measures tended to increase after transplantation but the changes did not reach statistical significance (P > 0.05).
  
  
  CONCLUSIONS
  Renal transplantation provides the improvement of uremic cardiac sympathetic neuropathy assessed by (123)I-MIBG imaging, which may be a more sensitive or at least an earlier marker than HRV.
authors.affiliation: Department of Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan. kurata-c@post.yamaha.co.jp
authors.forename: Chinori
authors.initials: C
authors.lastname: Kurata
authors.forename: Akihiko
authors.initials: A
authors.lastname: Uehara
authors.forename: Akira
authors.initials: A
authors.lastname: Ishikawa
mesh_terms: D019797:3-Iodobenzylguanidine; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery / Q000628:therapy; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy; D002648:Child; D005260:Female; D006339:Heart Rate; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging* / Q000601:surgery* / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D006435:Renal Dialysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine