Left Ventricular Reverse Remodeling After Successful Living Donor Kidney Transplantation: The VINTAGE Study.

Abstract

Background: The impact of kidney transplantation (KT) on left ventricular (LV) remodeling remains poorly understood. This study aimed to evaluate the effect of KT on LV reverse remodeling, utilizing echocardiographic LV geometric patterns as a key assessment tool.

Methods: 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, eccentric hypertrophy, and concentric hypertrophy) between baseline and 1 year post-transplantation. These patterns were categorized based on LV mass index (LVMI) and relative wall thickness (RWT) assessed via echocardiography.

Results: 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 concentric remodeling from 30% to 45%, while eccentric hypertrophy decreased markedly from 20% to 3%. Concentric hypertrophy remained relatively stable at 33% (p=0.036). Subgroup analysis revealed that 47% of those with pre-KT normal geometry progressed to LV remodeling, while 77% with concentric remodeling remained stable. In contrast, 55% with eccentric hypertrophy experienced reverse remodeling, and 49% with concentric hypertrophy also showed reverse remodeling. These subgroup results suggest an interaction between the effect of KT on LV reverse remodeling and the pre-KT LV geometric patterns. Multivariable analysis identified E/e' > 9.5 (OR 2.01, 95% CI 1.10-3.67, p=0.024) and acute antibody-mediated rejection (OR 2.44, 95% CI 1.01-5.87, p=0.047) as independent predictors of LV remodeling progression.

Conclusions: 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. Since recipients rarely achieve complete renal recovery, echocardiographic monitoring remains crucial post-KT. Future studies are needed to establish whether these observed improvements in LV reverse remodeling directly translate into long-term reductions in cardiovascular events.