Silent cardiac burden: Echocardiographic abnormalities and their predictors in kidney transplant candidates and their impact on graft function

BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients (KTRs). Despite cardiac clearance, potential KTRs still have structural and functional abnormalities. Identifying the prevalence of these abnormalities and understanding their predictors is vital for optimizing pre-transplant risk stratification and improving post-transplant outcomes. AIM To determine the prevalence of left ventricular hypertrophy (LVH), left ventricular systolic dysfunction (LVSD), diastolic dysfunction (DD), pulmonary hypertension (PH), and their predictors, and to assess their impact on graft function in pre-transplant candidates. METHODS The study included all successful transplant candidates older than 14 who had a baseline echocardiogram. Binary logistic regression models were constructed to identify factors associated with LVH, LVSD, DD, and PH. RESULTS Out of 259 patients, LVH was present in 64% (166), 12% (31) had LVSD, 27.5% (71) had DD, and 66 (25.5%) had PH. Independent predictors of LVH included male gender [odds ratio (OR): 2.51; 95%CI: 1.17–5.41 P = 0.02], PH (OR = 2.07; 95%CI: 1.11–3.86; P = 0.02), DD (OR: 2.47; 95%CI: 1.29–4.73; P = 0.006), and dyslipidemia (OR = 1.94; 95%CI: 1.07–3.53; P = 0.03). Predictors for LVSD included patients with DD (OR = 3.3, 95% CI: 1.41–7.81; P = 0.006) and a family history of coronary artery disease (OR = 4.50, 95%CI: 1.33–15.20; P = 0.015). Peritoneal dialysis was an independent predictor for DD (OR = 10.03; 95%CI: 1.71-58.94, P = 0.011). The presence of LVH (OR = 3.32, 95%CI: 1.05–10.55, P = 0.04) and mild to moderate or moderate to severe mitral regurgitation (OR = 4.63, 95%CI: 1.45–14.78, P = 0.01) were significant factors associated with PH. These abnormalities had no significant impact on estimated glomerular filtration at discharge, 6 months, 1 year, or 2 years post-transplant. CONCLUSION Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance, although they don’t affect future graft function. Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre- and post-transplant to achieve better outcomes.