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.