Joseph Megan S, Tinney Francis, Naik Abhijit, Parasuraman Raviprasenna, Samaniego-Picota Milagros, Bhave Nicole M
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School and Michigan Medicine, Ann Arbor, Michigan, USA.
Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA.
Cardiorenal Med. 2021;11(2):109-118. doi: 10.1159/000515124. Epub 2021 Apr 14.
Pulmonary hypertension is common among patients with end-stage renal disease, although data regarding the impact of right ventricular (RV) failure on postoperative outcomes remain limited. We hypothesized that echocardiographic findings of RV dilation and dysfunction are associated with adverse clinical outcomes after renal transplant.
A retrospective review of adult renal transplant recipients at a single institution from January 2008 to June 2010 was conducted. Patients with transthoracic echocardiograms (TTEs) within 1 year leading up to transplant were included. The primary end point was a composite of delayed graft function, graft failure, and all-cause mortality.
Eighty patients were included. Mean follow-up time was 9.4 ± 0.8 years. Eight patients (100%) with qualitative RV dysfunction met the primary end point, while 39/65 patients (60.0%) without RV dysfunction met the end point (p = 0.026). Qualitative RV dilation was associated with a significantly shorter time to all-cause graft failure (p = 0.03) and death (p = 0.048). RV systolic pressure was not measurable in 45/80 patients (56%) and was not associated with outcomes in the remaining patients.
RV dilation and dysfunction are associated with adverse outcomes after renal transplant. TTE assessment of RV size and function should be a standard part of the pre-kidney transplant cardiovascular risk assessment.
肺动脉高压在终末期肾病患者中很常见，尽管关于右心室（RV）衰竭对术后结局影响的数据仍然有限。我们假设右心室扩张和功能障碍的超声心动图表现与肾移植术后不良临床结局相关。
对2008年1月至2010年6月在单一机构接受成人肾移植的患者进行回顾性研究。纳入在移植前1年内进行经胸超声心动图（TTE）检查的患者。主要终点是移植肾功能延迟、移植失败和全因死亡率的综合指标。
共纳入80例患者。平均随访时间为9.4±0.8年。8例（100%）有定性右心室功能障碍的患者达到主要终点，而65例无右心室功能障碍的患者中有39例（60.0%）达到终点（p=0.026）。定性右心室扩张与全因移植失败（p=0.03）和死亡（p=0.048）的时间显著缩短相关。80例患者中有45例（56%）无法测量右心室收缩压，其余患者中右心室收缩压与结局无关。
右心室扩张和功能障碍与肾移植术后不良结局相关。术前通过TTE评估右心室大小和功能应成为肾移植前心血管风险评估的标准组成部分。
