title: Significant benefits after renal transplantation in patients with chronic heart failure and chronic kidney disease.
abstract: BACKGROUND
  Chronic heart failure (CHF) and chronic kidney disease (CKD) are serious medical conditions with significant morbidity and mortality and often coexist. Because of perioperative risks in these patients, they may not be considered a candidate for renal transplantation (RTx).
  
  
  METHODS
  We compare retrospectively RTx outcomes [graft/patient survival, rejection rates and adverse cardiac events] in study group [low left ventricular ejection fraction (LVEF) ≤ 45% by echocardiogram, n = 63] and control group [normal LVEF ≥ 50%, n = 537] from a developing country.
  
  
  RESULTS
  The mean EF was 35 ± 5.6 and 57 ± 3% for the study and control groups, respectively (p < 0.001). Majority of these patients (98%) showed normalization of LVEF post-transplant. The median EF was 60% at 1-3 months post-transplant. No difference was noted in graft survival, patient survival, rejection rates, serum creatinine and adverse cardiac events of study group at 1.3-year mean follow-up compared to control group. Outcome was not adversely affected by preexisting LV dysfunction. The study and control groups had nearly similar percent of patients with established CAD but significantly more hospitalization for CHF pre RTx in the study group compared with the control group.
  
  
  CONCLUSIONS
  RTx may play a role in reversing LV systolic dysfunction. Once thought by many to be a contraindication for renal transplantation, this appears not to be the case. The outcomes between the 2 groups are comparable and transplant is an option for even low EF patients.
authors.affiliation: Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences, (IKDRC-ITS) , Ahmedabad , India .
authors.forename: Vivek B
authors.initials: VB
authors.lastname: Kute
authors.forename: Aruna V
authors.initials: AV
authors.lastname: Vanikar
authors.forename: Himanshu V
authors.initials: HV
authors.lastname: Patel
authors.forename: Manoj R
authors.initials: MR
authors.lastname: Gumber
authors.forename: Pankaj R
authors.initials: PR
authors.lastname: Shah
authors.forename: Divyesh P
authors.initials: DP
authors.lastname: Engineer
authors.forename: Manish R
authors.initials: MR
authors.lastname: Balwani
authors.forename: Rajesh Singh
authors.initials: RS
authors.lastname: Gautam
authors.forename: Pranjal R
authors.initials: PR
authors.lastname: Modi
authors.forename: Veena R
authors.initials: VR
authors.lastname: Shah
authors.forename: Hargovind L
authors.initials: HL
authors.lastname: Trivedi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007194:India / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume; D055815:Young Adult
keywords: Chronic heart failure; chronic kidney disease; low ejection fraction; outcome; renal transplantation