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Int J Med Sci 2016; 13(8):620-628. doi:10.7150/ijms.15745 This issue Cite

Research Paper

Predictive Value of Echocardiographic Abnormalities and the Impact of Diastolic Dysfunction on In-hospital Major Cardiovascular Complications after Living Donor Kidney Transplantation

Eun Jung Kim^1,2, Suyon Chang³, So Yeon Kim^1,2, Kyu Ha Huh⁴, Soojeong Kang¹, Yong Seon Choi^1,2✉

1. Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea;
2. Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea;
3. Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea;
4. Department of Transplantation Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

✉ Corresponding author: Yong Seon Choi, MD, PhD. Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea. Office Phone: +82-2-2228-2412 Fax: +82-2-2227-7897 E-mail: YSCHOIac. More

Abstract

Patients with end-stage renal disease (ESRD) show characteristic abnormalities in cardiac structure and function. We evaluated the influence of these abnormalities on adverse cardiopulmonary outcomes after living donor kidney transplantation in patients with valid preoperative transthoracic echocardiographic evaluation. We then observed any development of major postoperative cardiovascular complications and pulmonary edema until hospital discharge. In-hospital major cardiovascular complications were defined as acute myocardial infarction, ventricular fibrillation/tachycardia, cardiogenic shock, newly-onset atrial fibrillation, clinical pulmonary edema requiring endotracheal intubation or dialysis. Among the 242 ESRD study patients, 9 patients (4%) developed major cardiovascular complications, and 39 patients (16%) developed pulmonary edema. Diabetes, ischemia-reperfusion time, left ventricular end-diastolic diameter (LVEDd), left ventricular mass index (LVMI), right ventricular systolic pressure (RVSP), left atrium volume index (LAVI), and high E/E' ratios were risk factors of major cardiovascular complications, while age, LVEDd, LVMI, LAVI, and high E/E' ratios were risk factors of pulmonary edema. The optimal E/E' cut-off value for predicting major cardiovascular complications was 13.0, showing 77.8% sensitivity and 78.5% specificity. Thus, the patient's E/E' ratio is useful for predicting in-hospital major cardiovascular complications after kidney transplantation. We recommend that goal-directed therapy employing E/E' ratio be enacted in kidney recipients with baseline diastolic dysfunction to avert postoperative morbidity. (http://Clinical Trials.gov number: NCT02322567)

Keywords: living donor kidney transplantation, end-stage renal disease, diastolic dysfunction, pulmonary edema, tissue Doppler imaging.

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