Improvement of cardiac sympathetic innervation by renal transplantation.
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.
Kurata
Chinori
C
Department of Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan. kurata-c@post.yamaha.co.jp
Uehara
Akihiko
A
Ishikawa
Akira
A
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
D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine