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Echocardiography-based score to predict outcome after renal transplantation
  1. Rajan Sharma1,
  2. Eric Chemla1,
  3. Maite Tome2,
  4. Rajnikant L Mehta3,
  5. Helen Gregson1,
  6. Stephen J D Brecker1,
  7. Rene Chang1,
  8. Denis Pellerin2
  1. 1Departments of Cardiology and Renal Medicine, St George’s Hospital, London, UK
  2. 2The Heart Hospital, London, UK
  3. 3Department of Medical Statistics, Southampton University Hospital, Southampton, UK
  1. Correspondence to:
    Dr D Pellerin
    The Heart Hospital, 16–18 Westmoreland Street, London W1G 8PH, UK; denis.pellerin{at}uclh.nhs.uk

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.

  • LVEF, left ventricular ejection fraction
  • LVESD, left ventricular end-systolic diameter

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Footnotes

  • Published Online First 15 September 2006

  • Competing interests: None.

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