Introduction:
Patients with Left Ventricular dysfunction are often considered poor candidates for Kidney Transplant(KT) because they are at high risk for perioperative complications. The presence of coexisting cardiac disease in these candidates amass the challenges and complexities. Cardiac diseases, encompassing conditions such as Coronary Artery Disease(CAD),Congestive Heart Failure, Cardiomyopathy, Valvular diseases are prevalent in patients with End stage Renal Disease. The less clearly defined agenda for prioritizing Cardiovascular disease(CVD) related morbidity and mortality as a modifiable outcome tends to fall into a snapshot assessment Pre transplant rather than on a continuum to post transplant sphere.
Methods:
A single center prospective study including all patients with cardiac disease undergoing Renal transplant. Patients at risk underwent noninvasive screening Dobutamine stress Echocardiogram and further were subjected to Percutaneous Coronary Angiography (CAG) if indicated. Those with significant CAD were offered Percutaneous Coronary Angioplasty(PTCA) or Coronary Artery Bypass Grafting(CABG) prior to proceeding for KT. Patients with valvular diseases underwent Valvular replacement.
Results:
Our study included 50 patients with cardiac diseases who underwent KT. 34% of these had Diabetes and 94% had Hypertension. Mean Ejection Fraction (EF) pre transplant was 25.52 ±18.26 % Of which 72 % had EF ≤ 40 % and 13.8 % had EF as low as 20- 25 %. Left Ventricular Hypertrophy(LVH) was seen in 80% of patients. 26% of patient had Pericardial Effusion and 88% patient had Hypokinesia. 3 patients were s/p PTCA, and 1 had history of CABG in previous years before transplant. 16 % (8) patients were subjected to CAG for cardiac clearance prior to KT; of which 75 % were offered interventions. 4 patients underwent elective PTCA and 2 elective CABG. Three (6%) had valvular disease which followed a stormy course of 2 patient undergoing Double Valve Replacement and 1 patient underwent Mitral valve replacement prior to KT. 6% patient had Congenital Heart Disease (Ostium secundum, stretched PFO, s/p VSD closure). 8% had Vegetation. Patients were followed over regular intervals for Graft and cardiac function assessment. Study data evaluated at one year showed a significant rise in mean EF to 54.46 ± 7.99%.LVH resolved completely in 35% of patients. Hypokinesia persisted in 18 % which was regional, although majority of these showed improvement in EF as uremic cardiomyopathy improved. Pericardial effusion was completely recovered. Following Transplant 2 patient(4%) had cardiac events. They underwent CAG followed by PTCA in one and medical management for other. No additional cardiac event has been documented till now. At one year follow up all 50 patients maintained a good Renal graft function with mean serum Creatinine of 1.43±0.44 mg/dl and Spot Urinary protein to creatinine ratio of 0.50 ±0.86 gm/gm.
Conclusions:
The presence of cardiac disease not only affects the peri-operative risk but also has implications for long-term graft function and patient survival. Pre-transplant elective cardiac intervention in selected patient could be beneficial. Also, Renal transplant has significant impact on Cardiac function and improvement in overall quality of life.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.