FUNCTIONAL MITRAL REGURGITATION FOLLOWING SUCCESSFUL LIVING DONOR KIDNEY TRANSPLANT: THE VINTAGE STUDY

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https://storage.unitedwebnetwork.com/files/1099/421e69c6f80ce2fd3e5fe2d17da91b49.pdf

Abstract Title *

FUNCTIONAL MITRAL REGURGITATION FOLLOWING SUCCESSFUL LIVING DONOR KIDNEY TRANSPLANT: THE VINTAGE STUDY

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Co-author 1

Sumi Hidaka s_hidaka@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan *

Co-author 2

Kei Omori 1998go258@gmail.com Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 3

Chika Shibuya e173039g@yokohama-cu.ac.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 4

Mizuki Yamano mizukiymn@yahoo.co.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 5

Yasuhiro Mochida yasuhiro.mochida@tokushukai.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 6

Tomoki Tsukahara ttsukahara1112@gmail.com Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 7

Kunihiro Ishioka kunihiro.ishioka@tokushukai.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 8

Machiko Oka m_oka@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 9

Kyoko Maesato kyoko.maesato@tokushukai.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 10

Hidekazu Moriya hidekazu.moriya@tokushukai.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 11

Takayasu Ohtake ohtake@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 12

Yusuke Tsukamoto y_tsukamoto2@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 13

Kazunari Tanabe kazunaritanabe0323@gmail.com Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 14

Shuzo Kobayashi shuzo@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 15

Introduction

Functional mitral regurgitation (FMR) is prevalent in chronic kidney disease (CKD) patients, but few studies have evaluated the effect of kidney transplantation (KT) on FMR. This study aimed to clarify KT's effect on FMR.

Methods

This study included 115 living donor KT recipients (2012-2023). Primary outcome was change in FMR severity (5 categories: none to severe) based on echocardiographic findings before and 1-year post-KT. Aortic regurgitation (AR) severity and changes in left atrial diameter (LAD), left ventricular end-diastolic dimension (LVDd), atrial natriuretic peptide (ANP), and brain natriuretic peptide (BNP) levels were also assessed. Change in FMR and AR severity was assessed using Wilcoxon signed-rank tests. Multivariable logistic regression models were used to identify factors associated with the worsening of FMR and AR.

Results

At baseline, 76.5% had trivial FMR; 22.6% had mild/moderate/severe FMR. One-year post-KT, moderate/severe FMR disappeared. Overall, FMR improved in 19.1%, remained unchanged in 73.1%, and worsened in 7.8%. FMR severity distribution significantly changed (P=0.004). Reductions in LAD/LVDd aligned with decreased ANP/BNP. Multivariable analysis identified only acute antibody-mediated rejection (ABMR) as an independent factor for worsening FMR (OR 4.02, 95% CI 1.81–8.91, P < 0.001). No significant AR improvement was observed (P=0.377).

Conclusion

KT effectively improves FMR in kidney failure (KF) patients. This is likely due to left atrial (LA)/ left ventricular (LV) reverse remodeling from reduced volume/pressure overload. However, this benefit may diminish with graft dysfunction (e.g., acute rejection). Our findings highlight another important cardioprotective benefit of successful KT. Conversely, KT does not appear to directly improve AR.

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