Hidaka Sumi, Kobayashi Shuzo, Tanabe Kazunari
Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan.
Kidney Transplant and Robotic Surgery Center, Shonan Kamakura General Hospital, Kanagawa, Japan.
Kidney360. 2025 Mar 1;6(3):461-469. doi: 10.34067/KID.0000000673. Epub 2024 Dec 12.
Kidney transplantation (KT) can improve even advanced left ventricular (LV) geometric patterns, but this effect may be attenuated by pre-KT decreased diastolic function and acute antibody-mediated rejection. Regardless of the pre-KT LV geometric pattern, the postoperative LV geometric pattern tended to shift toward concentric remodeling. Geometric patterns may be an easy-to-understand and useful cardiac function assessment tool for nephrologists.
The effect of kidney transplantation (KT) on left ventricular (LV) remodeling remains poorly understood. The aim of this study was to evaluate the effect of KT on LV reverse remodeling, using echocardiographic LV geometric patterns as a key assessment tool.
In 100 recipients who underwent living KT between 2012 and 2022, we evaluated changes in the distribution of LV geometric patterns (normal geometry, concentric remodeling [CR], eccentric hypertrophy [EH], and concentric hypertrophy [CH]) between baseline and 1 year after transplantation. These patterns were categorized on the basis of LV mass index and relative wall thickness assessed by echocardiography.
Overall, LV geometric patterns improved or remained stable in 81% of recipients, with worsening in 19%. The proportion of normal geometry increased from 15% to 19% and CR from 30% to 45%, whereas EH decreased markedly from 20% to 3%. CH remained relatively stable at 33% ( = 0.036). Subgroup analysis revealed that 47% of those with pre-KT normal geometry progressed to LV remodeling, whereas 77% with CR remained stable. By contrast, 55% with EH experienced reverse remodeling and 49% with CH also showed reverse remodeling. These subgroup results suggest an interaction between the effect of KT on LV reverse remodeling and pre-KT LV geometric patterns. Multivariable analysis identified E/e′ > 9.5 (odds ratio, 2.01; 95% confidence interval, 1.10 to 3.67; = 0.024) and acute antibody-mediated rejection (odds ratio, 2.44; 95% confidence interval, 1.01 to 5.87; = 0.047) as independent predictors of LV remodeling progression.
KT can lead to improvements in even advanced LV geometric patterns, although this effect may be diminished in the presence of pre-KT diastolic dysfunction or the occurrence of acute rejection. Because recipients rarely achieve complete renal recovery, echocardiographic monitoring remains crucial after KT. Future studies are needed to establish whether these observed improvements in LV reverse remodeling directly translate into long-term reductions in cardiovascular events.
肾移植（KT）即使对晚期左心室（LV）几何形态也能起到改善作用，但这种效果可能会因肾移植前舒张功能下降和急性抗体介导的排斥反应而减弱。无论肾移植前左心室几何形态如何，术后左心室几何形态都倾向于向向心性重塑转变。几何形态对于肾病学家来说可能是一种易于理解且有用的心脏功能评估工具。
肾移植（KT）对左心室（LV）重塑的影响仍知之甚少。本研究的目的是使用超声心动图左心室几何形态作为关键评估工具，评估肾移植对左心室逆向重塑的影响。
在2012年至2022年间接受活体肾移植的100名受者中，我们评估了移植前基线和移植后1年之间左心室几何形态（正常形态、向心性重塑[CR]、离心性肥厚[EH]和向心性肥厚[CH]）分布的变化。这些形态是根据超声心动图评估的左心室质量指数和相对壁厚度进行分类的。
总体而言，81%的受者左心室几何形态得到改善或保持稳定，19%的受者情况恶化。正常形态的比例从15%增加到19%，向心性重塑从30%增加到45%，而离心性肥厚从20%显著下降到3%。向心性肥厚保持相对稳定，为33%（P = 0.036）。亚组分析显示，肾移植前左心室形态正常的受者中有47%进展为左心室重塑，而向心性重塑的受者中有77%保持稳定。相比之下，离心性肥厚的受者中有55%经历了逆向重塑，向心性肥厚的受者中有49%也表现出逆向重塑。这些亚组结果表明肾移植对左心室逆向重塑的影响与肾移植前左心室几何形态之间存在相互作用。多变量分析确定E/e′>9.5（比值比，2.01；95%置信区间，1.10至3.67；P = 0.024）和急性抗体介导排斥反应（比值比，2.44；95%置信区间，1.01至5.87；P = 0.047）是左心室重塑进展的独立预测因素。
肾移植即使对晚期左心室几何形态也能带来改善，尽管在肾移植前存在舒张功能障碍或发生急性排斥反应时这种效果可能会减弱。由于受者很少能实现完全的肾功能恢复，肾移植后超声心动图监测仍然至关重要。未来需要开展研究，以确定观察到的左心室逆向重塑改善是否能直接转化为心血管事件长期发生率的降低。
