title: Echocardiography-based score to predict outcome after renal transplantation.
abstract: BACKGROUND
  Given the high cardiac mortality of renal transplant recipients, identification of high-risk patients is important to offer appropriate treatment before transplantation.
  
  
  OBJECTIVE
  To determine patients with high mortality after renal transplantation despite selection according to current criteria.
  
  
  METHODS
  Preoperative parameters were collected from 203 renal transplant recipients over a follow-up time of 3.6 (1.9) years. The primary end point was all-cause mortality.
  
  
  RESULTS
  22 deaths (11%) and 12 cardiac failures (6%) were observed. Non-survivors were older (p< or =0.001), had larger left ventricular end-systolic diameter (LVSD) (p< or =0.001) and end-diastolic diameter (p = 0.002), and lower ejection fraction (p< or =0.001). Left ventricular mass index (p = 0.001), maximal wall thickness (p = 0.006) and the proportion with mitral annular calcification (p = 0.001) were significantly higher in the non-survivors. The risk factors for ischaemic heart disease and exercise test data were not significantly different between the two groups. Four independent predictors of mortality after renal transplantation were identified: age > or =50 years (p = 0.002), LVESD > or =3.5 cm (p = 0.002), maximal wall thickness > or =1.4 cm (p = 0.014) and mitral annular calcification (p = 0.036). The 5-year survival estimates for 0, 1, 2 and 3 prognostic factors were 96%, 86%, 69% and 38%, respectively. No patient had four prognostic factors. In patients > or =50 years, the 5-year survival estimates for 0, 1 and 2 additional prognostic factors were 73%, 45% and 18%, respectively.
  
  
  CONCLUSIONS
  In addition to selection according to current guidelines, age and three conventional echocardiography parameters may further improve risk stratification before renal transplantation.
authors.affiliation: Departments of Cardiology and Renal Medicine, St George's Hospital, London, UK.
authors.forename: Rajan
authors.initials: R
authors.lastname: Sharma
authors.forename: Eric
authors.initials: E
authors.lastname: Chemla
authors.forename: Maite
authors.initials: M
authors.lastname: Tome
authors.forename: Rajnikant L
authors.initials: RL
authors.lastname: Mehta
authors.forename: Helen
authors.initials: H
authors.lastname: Gregson
authors.forename: Stephen J D
authors.initials: SJ
authors.lastname: Brecker
authors.forename: Rene
authors.initials: R
authors.lastname: Chang
authors.forename: Denis
authors.initials: D
authors.lastname: Pellerin
mesh_terms: D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality*; D004452:Echocardiography / Q000592:standards; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000000981:diagnostic imaging / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D018579:Patient Selection; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome