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 (ESRD), heart failure (HF) with reduced ejection fraction (EF) is also observed in a small group. Kidney transplantation (KT) is generally avoided, due to increased risk of mortality in addition to the risks faced by HF. A prospective study was planned to follow patients with HF and being prepared for KT.

METHODS
25 patients with HF due to uremic cardiomyopathy (UC) who have suitable donor (group 1), 22 patients who had HF but couldn't have a KT due lack of kidney donor (group3) and 25 KT candidates with normal ventricular function (group2) were chosen. Left ventricular EF, left atrial diameter (LAD), mitral annular systolic velocity (Sm), left ventricular global longitudinal strain (GLS), left ventricular mass index (LVMI) values were recorded at four sessions; from pre-transplant to the end of 6 months posttransplantation. Endomyocardial biopsy was performed for detailed examination of the myocardium in patients in group 1 and group 3; Cardiac MRI was performed in all three groups.

RESULTS
LVEF, Sm; LV-GLS increased significantly while LAD and LVMI were decreased and all reached to normal levels in group1 while there were no changes in group3 and group2. (p<0,01 for LV-EF; p<0,01 for GLS; p<0,01 for LAD and p<0,01 for LVMI measurements) There was no difference in cardiac MRI and biopsy findings between group 1 and group 3.
Conclusıon: Since myocardial functions improved significantly and normalized in all patients with HF; it has been proven that UC can be substantially reversible when treated with KT.