Clinical research
Heart failure
Effect of kidney transplantation on left ventricular systolic dysfunction and congestive heart failure in patients with end-stage renal disease

https://doi.org/10.1016/j.jacc.2004.11.061Get rights and content
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Objectives

We examined the impact of kidney transplantation on left ventricular ejection fraction (LVEF) in end-stage renal disease (ESRD) patients with congestive heart failure (CHF).

Background

The ESRD patients with decreased LVEF and a poor New York Heart Association (NYHA) functional class are not usually referred for transplant evaluations, as they are considered to be at increased risk of cardiac and surgical complications.

Methods

Between June 1998 and November 2002, 103 recipients with LVEF ≤40% and CHF underwent kidney transplantation. The LVEF was re-assessed by radionuclide ventriculography gated-blood pool (MUGA) scan at six and 12 months and at the last follow-up during the post-transplant period.

Results

Mean pre-transplant LVEF% increased from 31.6 ± 6.7 (95% confidence interval [CI] 30.3 to 32.9) to 52.2 ± 12.0 (95% CI 49.9 to 54.6, p = 0.002) at 12 months after transplantation. There was no perioperative death. After transplantation, 69.9% of patients achieved LVEF ≥50% (normal LVEF). A longer duration of dialysis (in months) before transplantation decreased the likelihood of normalization of LVEF in the post-transplant period (odds ratio 0.82, 95% CI 0.74 to 0.91; p < 0.001). The NYHA functional class improved significantly in those with normalization of LVEF (p = 0.003). After transplantation, LVEF >50% was the only significant factor associated with a lower hazard for death or hospitalizations for CHF (relative risk 0.90, 95% CI 0.86 to 0.95; p < 0.0001).

Conclusions

Kidney transplantation in ESRD patients with advanced systolic heart failure results in an increase in LVEF, improves functional status of CHF, and increases survival. To abrogate the adverse effects of prolonged dialysis on myocardial function, ESRD patients should be counseled for kidney transplantation as soon as the diagnosis of systolic heart failure is established.

Abbreviations and acronyms

ACE
angiotensin-converting enzyme
CABG
coronary artery bypass graft
CHF
congestive heart failure
ESRD
end-stage renal disease
LVEF
left ventricular ejection fraction
MUGA
radionuclide ventriculography gated-blood pool scan
NYHA
New York Heart Association
PTCA
percutaneous transluminal coronary angioplasty
PTH-I
intact parathyroid hormone
URR
urea reduction ratio

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