The Impact of Perioperative Factors on Changes in Diastolic Function after Kidney Transplantation: A Retrospective Analysis
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Purpose: Cardiac changes in end-stage renal disease are the most common causes of death after kidney transplantation (KT). Chronic kidney disease presents a major risk factor for the development and progression of diastolic dysfunction. The purpose ofthis study was to identify the association between changes in left ventricular (LV) diastolic function and perioperative clinical factorsin patients with preserved ejection fraction following KT. Materials and Methods: We reviewed 115 patients who underwent KT between January 2011 and December 2015 with both preandpost-transplant echocardiograms; patients with LV systolic dysfunction were excluded. LV diastolic function was measuredusing the ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e’). Results: Patients with normal pre-operative LV systolic function (n=97) showed improvement in E/e’ after KT (11.9±4.4 to10.5±3.8, p=0.023). Additionally, post-KT estimated glomerular filtration ratio was associated with changes in E/e’ (odds ratio,-0.056; 95% confidence interval, -0.014 to -0.007; p=0.026). Among patients with preexisting diastolic dysfunction (20/97 patients),the amount of intraoperative fluid administration was related to E/e’ changes (odds ratio, 0.003; 95% confidence interval, 0.000 to0.005; p=0.029). Conclusion: KT is associated with improved diastolic function. Post-KT renal function was significantly related to changes in LVdiastolic function. The amount of intraoperative fluid was a risk factor for worsening diastolic function after KT in patients withpreexisting diastolic dysfunction.
Abstract
Purpose: Cardiac changes in end-stage renal disease are the most common causes of death after kidney transplantation (KT). Chronic kidney disease presents a major risk factor for the development and progression of diastolic dysfunction. The purpose ofthis study was to identify the association between changes in left ventricular (LV) diastolic function and perioperative clinical factorsin patients with preserved ejection fraction following KT. Materials and Methods: We reviewed 115 patients who underwent KT between January 2011 and December 2015 with both preandpost-transplant echocardiograms; patients with LV systolic dysfunction were excluded. LV diastolic function was measuredusing the ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e’). Results: Patients with normal pre-operative LV systolic function (n=97) showed improvement in E/e’ after KT (11.9±4.4 to10.5±3.8, p=0.023). Additionally, post-KT estimated glomerular filtration ratio was associated with changes in E/e’ (odds ratio,-0.056; 95% confidence interval, -0.014 to -0.007; p=0.026). Among patients with preexisting diastolic dysfunction (20/97 patients),the amount of intraoperative fluid administration was related to E/e’ changes (odds ratio, 0.003; 95% confidence interval, 0.000 to0.005; p=0.029). Conclusion: KT is associated with improved diastolic function. Post-KT renal function was significantly related to changes in LVdiastolic function. The amount of intraoperative fluid was a risk factor for worsening diastolic function after KT in patients withpreexisting diastolic dysfunction.
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