Recovery of Myocardial Functions After Kidney Transplantation in Patients with Heart Failure Due to Uremic Cardiomyopathy

OBJECTIVE
Although left ventricular hypertrophy frequently accompanies end-stage renal disease, heart failure (HF) with reduced ejection fraction (EF) is also observed in a subset of patients. In those patients kidney transplantation (KT) is generally avoided due to an increased risk of mortality in addition to the risks associated with HF. This prospective study was designed to follow patients with HF who were being prepared for KT.


METHODS
Twenty-five patients with HF due to uremic cardiomyopathy (UC) who had suitable donors (Group 1), 22 patients with HF who could not undergo KT due to a lack of kidney donors (Group 3), and 25 KT candidates with normal ventricular function (Group 2) were included in the study. Left ventricular ejection fraction (LVEF), left atrial diameter (LAD), mitral annular systolic velocity (Sm), left ventricular global longitudinal strain (GLS), and left ventricular mass index (LVMI) values were recorded across four sessions, from pre-transplant to six months post-transplantation. Endomyocardial biopsy was performed for detailed examination of the myocardium in patients in Group 1 and Group 3, and cardiac magnetic resonance imaging (MRI) was performed in all three groups before transplantation.


RESULTS
In Group 1, LVEF, Sm, and left ventricular global longitudinal strain (LV-GLS) increased significantly, while LAD and LVMI decreased, all reaching normal levels. In contrast, no changes were observed in Group 3 and Group 2 (P < 0.01 for LVEF, P < 0.01 for GLS, P < 0.01 for LAD, and P < 0.01 for LVMI measurements). No differences in cardiac MRI and biopsy findings were observed between Group 1 and Group 3.


CONCLUSION
Since myocardial function improved significantly and normalized in all patients with HF, it has been demonstrated that UC can be substantially reversible when treated with KT.