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, Suyon Chang, So Yeon Kim, Kyu Ha Huh, Soojeong Kang, Yong Seon Choi, Eun Jung Kim, Suyon Chang, So Yeon Kim, Kyu Ha Huh, Soojeong Kang, Yong Seon Choi

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

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Comparison of changes in arterial oxygen pressure during kidney transplantation surgery regarding development of postoperative (a) pulmonary edema and no pulmonary edema or (b) major cardiovascular complications and no cardiovascular complications. pO2, arterial oxygen pressure; non-PE, no postoperative pulmonary edema; PE, postoperative pulmonary edema; non-CV, no major postoperative cardiovascular complications; CV, major postoperative cardiovascular complications; T0, before surgery (baseline); T1, 60 minutes after surgery; T2, 10 minutes after kidney graft reperfusion; T3, end of surgery. *P

Figure 2

Receiver-operating characteristic (ROC) curve for…

Figure 2

Receiver-operating characteristic (ROC) curve for the E/E' ratio's prediction of postoperative major cardiovascular…

Figure 2
Receiver-operating characteristic (ROC) curve for the E/E' ratio's prediction of postoperative major cardiovascular complications. The ROC area under the ROC curve was 0.84 (95% confidence interval: 0.787-0.884; P < 0.001).

Figure 3

Comparison of changes in postoperative…

Figure 3

Comparison of changes in postoperative renal function as indicated by means of creatinine…

Figure 3
Comparison of changes in postoperative renal function as indicated by means of creatinine (Cr), estimated glomerular filtration rate (eGFR), and daily urine output after kidney transplantation. Their relationship to the development of postoperative (a, c, e) pulmonary edema and no pulmonary edema or (b, d, f) major cardiovascular complications and no cardiovascular complications are shown. non-PE, no postoperative pulmonary edema; PE, postoperative pulmonary edema; non-CV, no major postoperative cardiovascular complications; CV, major postoperative cardiovascular complications. *P < 0.05 compared to either the PE or CV group.
Figure 2
Figure 2
Receiver-operating characteristic (ROC) curve for the E/E' ratio's prediction of postoperative major cardiovascular complications. The ROC area under the ROC curve was 0.84 (95% confidence interval: 0.787-0.884; P < 0.001).
Figure 3
Figure 3
Comparison of changes in postoperative renal function as indicated by means of creatinine (Cr), estimated glomerular filtration rate (eGFR), and daily urine output after kidney transplantation. Their relationship to the development of postoperative (a, c, e) pulmonary edema and no pulmonary edema or (b, d, f) major cardiovascular complications and no cardiovascular complications are shown. non-PE, no postoperative pulmonary edema; PE, postoperative pulmonary edema; non-CV, no major postoperative cardiovascular complications; CV, major postoperative cardiovascular complications. *P < 0.05 compared to either the PE or CV group.

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