Effect of kidney transplantation on left ventricular systolic dysfunction and congestive heart failure in patients with end-stage renal disease.
OBJECTIVE
We examined the impact of kidney transplantation on left ventricular ejection fraction (LVEF) in end-stage renal disease (ESRD) patients with congestive heart failure (CHF).


BACKGROUND
The ESRD patients with decreased LVEF and a poor New York Heart Association (NYHA) functional class are not usually referred for transplant evaluations, as they are considered to be at increased risk of cardiac and surgical complications.


METHODS
Between June 1998 and November 2002, 103 recipients with LVEF < or =40% and CHF underwent kidney transplantation. The LVEF was re-assessed by radionuclide ventriculography gated-blood pool (MUGA) scan at six and 12 months and at the last follow-up during the post-transplant period.


RESULTS
Mean pre-transplant LVEF% increased from 31.6 +/- 6.7 (95% confidence interval [CI] 30.3 to 32.9) to 52.2 +/- 12.0 (95% CI 49.9 to 54.6, p = 0.002) at 12 months after transplantation. There was no perioperative death. After transplantation, 69.9% of patients achieved LVEF > or =50% (normal LVEF). A longer duration of dialysis (in months) before transplantation decreased the likelihood of normalization of LVEF in the post-transplant period (odds ratio 0.82, 95% CI 0.74 to 0.91; p < 0.001). The NYHA functional class improved significantly in those with normalization of LVEF (p = 0.003). After transplantation, LVEF >50% was the only significant factor associated with a lower hazard for death or hospitalizations for CHF (relative risk 0.90, 95% CI 0.86 to 0.95; p < 0.0001).


CONCLUSIONS
Kidney transplantation in ESRD patients with advanced systolic heart failure results in an increase in LVEF, improves functional status of CHF, and increases survival. To abrogate the adverse effects of prolonged dialysis on myocardial function, ESRD patients should be counseled for kidney transplantation as soon as the diagnosis of systolic heart failure is established.
Wali
Ravinder K
RK
Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA. rwali@medicine.umaryland.edu
Wang
Gregory S
GS
Gottlieb
Stephen S
SS
Bellumkonda
Lavanya
L
Hansalia
Riple
R
Ramos
Emilio
E
Drachenberg
Cinthia
C
Papadimitriou
John
J
Brisco
Meredith A
MA
Blahut
Steve
S
Fink
Jeffrey C
JC
Fisher
Michael L
ML
Bartlett
Stephen T
ST
Weir
Matthew R
MR
D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D015635:Radionuclide Ventriculography; D013318:Stroke Volume; D016019:Survival Analysis; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*