Chronic kidney disease increases cardiovascular mortality in patients with predialysis kidney disease, in those on dialysis and in kidney transplant recipients. Structural and functional cardiac remodelling play a critical role in such cardiovascular mortality.1 LV structural remodelling such as diffuse interstitial fibrosis occurs in early chronic kidney disease and is associated with myocardial dysfunction.2 Among patients with chronic kidney disease, the prevalence of LV hypertrophy increases as renal function deteriorates.3 Its presence predicts future cardiovascular disease in this patient population.3 Several studies have shown that successful renal transplantation is associated with resolution of the LV hypertrophy.1 ,4 However, the association between LV remodelling after renal transplantation, and allograft outcome has not been fully explored. Thus, screening for cardiovascular benefits and complications is advocated for patients who have undergone renal transplantation.

In this issue of Heart, An et al5 report a retrospective analysis of cardiac function in long-term renal transplant recipients from two Korean medical centres in which transthoracic echocardiography was used to assess LV structure and function. They analysed 767 adult patients who underwent echocardiography before transplantation and at 1 week, 1 year and 5 years after transplantation. LV hypertrophy, defined as a LV mass index >95 g/m² for women and >115 g/m² for men, occurred in 71% (546/767) of these patients with chronic kidney disease before transplantation. The prevalence of LV hypertrophy decreased from 71% before transplantation to 66% at 1 year and to …