Echocardiography-based score to predict outcome after renal transplantation.
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.
Sharma
Rajan
R
Departments of Cardiology and Renal Medicine, St George's Hospital, London, UK.
Chemla
Eric
E
Tome
Maite
M
Mehta
Rajnikant L
RL
Gregson
Helen
H
Brecker
Stephen J D
SJ
Chang
Rene
R
Pellerin
Denis
D
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