Echocardiography based score to predict outcome after renaltransplantation

Rajan Sharma ^1*, Eric Chemla ¹, Maite Tome ², Rajnikant Mehta ³, Helen Gregson ¹, Stephen J D Brecker ¹, Rene Chang ¹ and Denis Pellerin ²

¹ St. Georges Hospital, London, United Kingdom
² The Heart Hospital, London, United Kingdom
³ Southampton General Hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: rsharma{at}tinyworld.co.uk.

Accepted 18 August 2006

Abstract

Background Given the high cardiac mortality of renal transplant recipients, identification of high - risk patients is important in order to offer appropriate therapy prior to transplantation. This study aimed to determine patients with high mortality after renal transplantation despite selection according to current criteria.

Methods Pre-operative parameters were collected in 203 renal transplant recipients over a follow-up time of 3.6 iÀ 1.9 years. The primary end point was all cause mortality.

Results There were 22 deaths (11%), 12 cardiac (6%.) Non survivors were older (p iÜ 0.001), had larger left ventricular end systolic diameter (p iÜ 0.001) and end diastolic diameter (p = 0.002), and lower ejection fraction (p iÜ 0.001). Left ventricular mass index (p 0.001), maximal wall thickness (p 0.006), the proportion with mitral annular calcification (p 0.001) were significantly higher in the non survivors. Risk factors for ischaemic heart disease and exercise test data were not significantly different between the 2 groups. Four independent predictors of mortality after renal transplantation were identified: age > 50 years (p 0.002), left ventricular end systolic diameter > 3.5 cm (p 0.002), maximal wall thickness > 1.4cm (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 4 prognostic factors. In patients over 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 3 conventional echocardiography parameters may further improve risk stratification before renal transplantation.

Keywords: echocardiography, end stage renal disease, mortality, renal transplantation, uraemic cardiomyopathy

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Herzog, C. A. (2008). Kidney disease in cardiology. Nephrol Dial Transplant 23: 42-46 [Abstract] [Full Text]