Echocardiography-based score to predict outcome after renal transplantation. Issue 4 (15th September 2006)

• Record Type: Journal Article
• Authors: Sharma, Rajan; Chemla, Eric; Tome, Maite; Mehta, Rajnikant L; Gregson, Helen; Brecker, Stephen J D; Chang, Rene; Pellerin, Denis
• Is Part Of: Heart. Volume 93:Issue 4(2007)
• Page Start: 464
• Page End: 469
• Publication Date: 2006-09-15
• Subjects: LVEF, left ventricular ejection fraction -- LVESD, left ventricular end-systolic diameter; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/hrt.2006.096826
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Background: Given the high cardiac mortality of renal transplant recipients, identification of high-risk patients is important to offer appropriate treatment before transplantation. Aim: To determine patients with high mortality after renal transplantation despite selection according to current criteria. Methods: Preoperative parameters were collected from 203 renal transplant recipients over a follow-up time of 3.6 (1.9) years. The primary end point was all-cause mortality. Results: 22 deaths (11%) and 12 cardiac failures (6%) were observed. Non-survivors were older (p⩽0.001), had larger left ventricular end-systolic diameter (LVSD) (p⩽0.001) and end-diastolic diameter (p = 0.002), and lower ejection fraction (p⩽0.001). Left ventricular mass index (p = 0.001), maximal wall thickness (p = 0.006) and the proportion with mitral annular calcification (p = 0.001) were significantly higher in the non-survivors. The risk factors for ischaemic heart disease and exercise test data were not significantly different between the two groups. Four independent predictors of mortality after renal transplantation were identified: age ⩾50 years (p = 0.002), LVESD ⩾3.5 cm (p = 0.002), maximal wall thickness ⩾1.4 cm (p = 0.014) and mitral annular calcification (p = 0.036). The 5-year survival estimates for 0, 1, 2 and 3 prognostic factors were 96%, 86%, 69% and 38%, respectively. No patient had four prognostic factors. In patients ⩾50 years, the 5-year survival estimates for 0, 1 and 2 additional prognostic factors were 73%, 45% and 18%, respectively. Conclusion: In addition to selection according to current guidelines, age and three conventional echocardiography parameters may further improve risk stratification before renal transplantation.