title: Regression of asymptomatic cardiomyopathy and clinical outcome of renal transplant recipients: a long-term prospective cohort study.
abstract: Asymptomatic left ventricular hypertrophy (LVH) is highly prevalent and associated with an adverse outcome in renal transplant recipients (RTRs). Nonetheless, there are currently no available studies analyzing the effect of LVH regression on solid clinical endpoints in these patients.
  
  
  
  This study is the prospective observational extension of two randomized controlled trials aimed at assessing the effect of active intervention on post-transplant LVH in RTRs. We evaluated the incidence of a composite of death and any cardiovascular (CV) or renal event in 60 RTRs in whom LVH regression was observed and in 40 whose LVH remained unchanged or worsened.
  
  
  
  During an 8.4 ± 3.5-year follow-up, 8 deaths, 18 CV events and 6 renal events occurred in the entire cohort. Multivariable analysis showed that age [hazard ratio (HR) 1.07, 95% confidence interval (CI) 1.03-1.12 each 1 year, P = 0.002] and LVH regression (HR 0.42, 95% CI 0.22-0.87, P = 0.019) were significant predictors of the composite endpoint. Kaplan-Meier estimates showed better survival rates in patients in whom actual LVH regression was achieved (P < 0.001, log-rank test). Age (HR 1.09, 95% CI 1.03-1.15 each 1 year, P = 0.004), better graft function (HR 0.95, 95% CI 0.91-0.99 each 1 mL/min/1.73 m(2) increase in estimated glomerular filtration rate, P = 0.03) and LVH regression (HR 0.41, 95% CI 0.22-0.79, P = 0.01) were significant predictors of the CV endpoint. Patients with a left ventricular mass index decrease also showed better cardiac event-free survival (P = 0.0022, log-rank test).
  
  
  
  This is the first study to demonstrate that LVH regression, regardless of the therapeutic strategy adopted to achieve it, portends better long-term clinical outcome in RTRs.
authors.affiliation: Division of Nephrology, Dialysis, and Transplantation, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Paoletti
authors.affiliation: Division of Nephrology, Dialysis, and Transplantation, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Bellino
authors.affiliation: Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Signori
authors.affiliation: Division of Nephrology, Dialysis, and Transplantation, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pieracci
authors.affiliation: Division of Nephrology, Dialysis, and Transplantation, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy.
authors.forename: Luigina
authors.initials: L
authors.lastname: Marsano
authors.affiliation: Division of Nephrology, Dialysis, and Transplantation, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Russo
authors.affiliation: Division of Nephrology, Dialysis, and Transplantation, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Massarino
authors.affiliation: Division of Nephrology, Dialysis, and Transplantation, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Ravera
authors.affiliation: Kidney Transplant Unit, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy.
authors.forename: Iris
authors.initials: I
authors.lastname: Fontana
authors.affiliation: Division of Nephrology, Dialysis, and Transplantation, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Carta
authors.affiliation: Division of Cardiology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cassottana
authors.affiliation: Division of Nephrology, Dialysis, and Transplantation, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Garibotto
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000401:mortality / Q000473:pathology*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D066027:Transplant Recipients; D016896:Treatment Outcome
keywords: LVH regression; cardiovascular events; clinical outcome; renal transplantation