Cardiac Function in Children After Kidney Transplant

Objectives: Renal transplant improves echocardio-graphic markers of systolic and diastolic heart functions. The aim of this study was to evaluate the gradual changes in left and right ventricle functions in children and young adults before and after renal transplant. Materials and Methods: Thirty kidney recipients of median age 13 years (range, 5-19 years) were included the study. Tissue Doppler imaging from the septal and lateral mitral annulus of the left ventricle and free wall of the right ventricle was performed. Right ventricle systolic excursion velocity and tricuspid annular plane systolic excursion were calculated. Systolic and diastolic heart functions-which gained just before transplant, were compared with posttransplant early-term (6 months to 1 year) and long-term (longer than 1 year) functions. Results: Twelve patients received deceased-donor and 18 patients received living donor renal transplant. Follow-up after transplant was 44 +/- 23 months. Left ventricle ejection fractions were normal. The left ventricle, right ventricle, and interventricular septal Tei indices were significantly higher before transplant. The posttransplantation early- and late-term results of left ventricle, right ventricle, and interventricular septal Tei indices were similar. Tricuspid annular plane systolic excursion levels were abnormal in 11 patients (36%), and right ventricle systolic excursion velocities were abnormal in 7 patients (23%) before transplant. All tricuspid annular plane systolic excursion levels and 94% of right ventricle systolic excursion velocities were normal, but left ventricle Tei indices were higher in 8 (26%) and right ventricle Tei indices were higher in 14 patients (46%) at late-term follow-up. Conclusions: The systolic and diastolic dysfunctions of both ventricles appear to be highly prevalent in pediatric renal transplant recipients, especially soon after transplant, and were shown to usually decrease with time. Improvements in right ventricle dysfunction are slower, even in optimally treated posttransplant patients.