title: Left atrial diameter and survival among renal allograft recipients.
abstract: OBJECTIVE
  Sequential echocardiography is routinely performed in patients with ESRD listed for transplantation. The benefit of this labor- and time-intensive measure, however, remains unclear. Thus, this study elucidated the various obtained routine echocardiography parameters that best predicted mortality and graft survival after renal transplantation.
  
  
  METHODS
  This study investigated 553 first renal transplant recipients listed in the Austrian Dialysis and Transplant Registry between 1992 and 2011 who had echocardiographic analysis at transplantation and survived at least 1 year. Cox proportional hazards models with the purposeful selection algorithms for covariables were used to identify predictors of mortality and graft loss. A Fine and Gray model was used to evaluate cause-specific death.
  
  
  RESULTS
  During a median follow-up of 7.14 years, 81 patients died, and 59 patients experienced graft loss after the first year. The Kaplan-Meier analysis showed that 85% of patients with a left atrial diameter below the median of 53 mm were alive 10 years after transplantation, whereas only 70% of those patients with a left atrial diameter equal to or above the median had survived (P<0.001). In the multivariable model, left atrial diameter (per millimeter) independently predicted overall mortality (hazard ratio, 1.06; 95% confidence interval, 1.03 to 1.08; P<0.001) and cause-specific cardiac death (hazard ratio, 1.04; 95% confidence interval, 1.00 to 1.08; P=0.04). Functional graft loss was predicted by the right atrial diameter (hazard ratio, 1.04; 95% confidence interval, 1.02 to 1.07; P=0.001).
  
  
  CONCLUSIONS
  The left atrial diameter determined at transplantation predicted overall and cardiac mortality. Patients with widely enlarged left atria exhibit a considerably reduced life expectancy. It remains to be determined, however, whether renal transplantation is futile in these patients.
authors.affiliation: Departments of Nephrology and, ‡Cardiology, Medical University of Vienna, Vienna, Austria;, Departments of †Nephrology and, §Cardiology, Krankenhaus Elisabethinen, Linz, Austria, ‖Austrian Dialysis and Transplant Registry, Linz, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kainz
authors.forename: Georg
authors.initials: G
authors.lastname: Goliasch
authors.forename: Franz
authors.initials: F
authors.lastname: Wiesbauer
authors.forename: Thomas
authors.initials: T
authors.lastname: Binder
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Nesser
authors.forename: Regina
authors.initials: R
authors.lastname: Mascherbauer
authors.forename: Christian
authors.initials: C
authors.lastname: Ebner
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kramar
authors.forename: Julia
authors.initials: J
authors.lastname: Wilflingseder
authors.forename: Rainer
authors.initials: R
authors.lastname: Oberbauer
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D001317:Austria; D006332:Cardiomegaly / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D006085:Graft Survival; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography