Long-term changes in cardiac remodelling in prevalent kidney graft recipients

Background: Approximately 15% of kidney transplant (KT) recipients develop de novo heart failure after KT. There are scarce data reporting the long-term changes in cardiac structure and function among KT recipients. Despite the improvement in renal function, transplant-related complications as well as immunosuppressive therapy could have an impact on cardiac remodelling during follow-up. We aimed to describe the long-term changes in echocardiographic parameters in prevalent KT recipients and identify the clinical and laboratory factors associated with these changes. Methods: A centralised blinded review of two echocardiographic examinations after KT (on average after 17 and 39 months post-KT respectively) was performed among 80 patients (age 50.4 +/- 16.2, diabetes 13.8% pre-KT), followed by linear regression to identify clinico-biological factors related to echocardiographic changes. Results: Left atrial volume index (LAVI) increased significantly (34.2 +/- 10.8 mL/m(2) vs. 37.6 +/- 15.0 mL/m(2), annualised delta 3.1 +/- 11.4 mL/m(2)/year; p = 0.034) while left ventricular ejection fraction (LVEF) decreased (62.1 +/- 9.0% vs. 59.7 +/- 9.9%, annualised delta -2.7 +/- 13.6%/year; p = 0.04). Male sex (beta = 8.112 +/- 2.747; p < 0.01), pre-KT hypertension (beta = 9.725 +/- 4.156; p < 0.05), graft from expanded criteria donor (beta = 3.791 +/- 3.587; p < 0.05), and induction by anti-thymocyte globulin (beta = 7.920 +/- 2.974; p = 0.01) were associated with an increase in LAVI during follow-up. Higher haemoglobin (>12.9 g/dL) at the time of the first echocardiography (beta = 6.029 +/- 2.967; p < 0.05) and ACEi/ARB therapy (beta = 8.306 +/- 3.161; p < 0.05) were associated with an increase in LVEF during follow-up. Conclusion: This study confirms the existence of long-term cardiac remodelling after KT despite dialysis cessation, characterised by an increase in LAVI and a decrease in LVEF. A better management of anaemia and using ACEi/ARB therapy may prevent such remodelling.