Original Article
High Left Ventricular Filling Pressure on Doppler Echocardiography Is Associated With Graft Failure and Overall Mortality Following Kidney Transplantation

https://doi.org/10.1053/j.jvca.2015.10.006Get rights and content

Objective

Although E/e´ is prognostic of mortality in patients with end-stage renal disease (ESED), little is known about the prognostic implications of E/e´ following kidney transplant (KT). The objective of this study was to evaluate whether an elevated E/e´ is associated with graft function, postoperative hemodialysis, and overall mortality in end-stage renal disease patients following KT.

Design

A retrospective observational study.

Setting

Tertiary teaching hospital.

Participants

In total, 1,045 patients underwent KT at the authors’ hospital between January 2006 and December 2013.

Intervention

None.

Measurements and Main Results

Patients were divided into groups with an E/e´<15 or≥15, as assessed by preoperative echocardiography (median time from preoperative assessment of echocardiography to surgery: 37 days [IQR: 16-68 days]). Of 1,045 patients, 821 patients (78.6%) had an E/e´<15, and 224 patients (21.4%) had an E/e´≥15. Multivariate analysis indicated that age (odds ratio [OR]: 1.03; 95% confidence interval [CI]: 1.01-1.04, p = 0.001), diabetes mellitus (OR: 2.7; CI: 1.94-3.83, p<0.001), β-blocker (OR: 1.4; CI: 1.03-1.95, p = 0.034), left atrial dimension (OR: 1.07; CI: 1.04-1.11, p<0.001), and left ventricular mass index (OR: 1.02; CI: 1.01-1.03, p<0.001) are predictive of E/e´≥15. After adjustment using inverse probability of treatment weighting, E/e´≥15 also was associated independently with postoperative hemodialysis (OR: 2.0; 95% CI: 1.5–2.6, p<0.001), graft failure (OR: 1.7; 95% CI: 1.4-2.2; p<0.001), and overall mortality (hazard ratio [HR]: 3.2; 95% CI: 2.1-4.8, p<0.001).

Conclusions

Preoperative E/e´ is a prognostic indicator of overall mortality in ESRD patients undergoing KT.

Section snippets

Study Population

This retrospective study evaluated all patients who underwent KT between January 2006 and December 2013 at the authors’ institution. In total, 1,348 patients who underwent KT initially were included in the study population. Of these 1,348 patients, 303 patients were excluded, including 9 patients who were<18 years old, 135 patients with missing data on the E/e′, 19 patients with valvular heart disease, and 140 patients who underwent cadaveric KT. The study protocol was approved by the

Results

The median follow-up duration for the general patient population was 3.4 years (interquartile range: 1.7-5.5 years). Of 1,045 patients, 821 patients (78.6%) had an E/e´<15 (10.1±2.3), and 224 patients (21.4%) had an E/e´≥15 (18.6±4.0). Patients with an E/e′≥15 were older and had higher BMI and lower albumin and sodium levels. Moreover, patients with E/e′≥15 demonstrated higher incidences of diabetes, hypertension, coronary artery disease, cerebrovascular accident, and use of β-blockers and

Discussion

In the authors’ present study, they confirmed that an E/e´≥15 was associated with overall mortality in ESRD patients following KT. In addition, they found that an E/e´≥15 was associated with graft failure and postoperative hemodialysis. Notably, the authors’ current results showed that increased morbidity and mortality were sustained even after IPTW adjustment, indicating that the E/e´ measure was independently associated with mortality in ESRD patients following KT.

It generally is accepted

References (30)

  • R. Sharma et al.

    Mitral peak Doppler E-wave to peak mitral annulus velocity ratio is an accurate estimate of left ventricular filling pressure and predicts mortality in end-stage renal disease

    J Am Soc Echocardiogr

    (2006)
  • G.S. Hillis et al.

    Noninvasive estimation of left ventricular filling pressure by E/e′ is a powerful predictor of survival after acute myocardial infarction

    J Am Coll Cardiol

    (2004)
  • S. Kenchaiah et al.

    Risk factors for heart failure

    Medical Clinics of North America

    (2004)
  • United States Renal Data System

    Am J Kidney Dis

    (1997)
  • M.J. Sarnak et al.

    Kidney disease as a risk factor for development of cardiovascular disease: A statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention

    Circulation

    (2003)
  • View full text