Structural and functional echocardiographic abnormalities in children pre- and post-kidney transplant in Cape Town, South Africa
No Thumbnail Available
Date
2024
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Ababa University
Abstract
Introduction: Cardiovascular manifestations of chronic kidney disease (CKD) include structural
changes such as left ventricular hypertrophy (LVH) related to hypertension and fluid overload,
vascular wall thickening, and calcification. There are also functional abnormalities such as systolic
and diastolic dysfunction including - reduced ejection fraction (EF) and fractional shortening (FS),
diastolic dysfunction, arrhythmias, and increased stiffness of vessels. The risk of these
abnormalities worsens with a decreasing glomerular filtration rate (GFR).
The best treatment for patients with kidney failure is kidney transplantation. Candidates are usually
screened for cardiac abnormalities, and it is not uncommon to find echocardiographic
abnormalities.
It is important to study how patients with cardiac abnormalities on echocardiography (echo) do
during and after kidney transplantation to optimize pre-transplant treatment, peri-transplant care,
and short and long-term post-transplant care.
Objectives: The objective of this study is to identify patients with KF who had structural and
functional cardiac abnormalities on echo before kidney transplant and to determine whether these
abnormalities improved or worsened post-transplant.
Method: Single-center retrospective review of children with cardiac abnormalities on echo who
had kidney transplants from 1st January 2018 to 31st Dec 2023 at Red Cross War Memorial
Children’s Hospital (RCWMCH).
Result: Thirty-two patients out of forty-three (74%) had echocardiographic screening within one
year before kidney transplant. Out of these 15/32 (46.9%) had abnormal structural or functional
echocardiographic findings before transplant. Of the abnormal echocardiography, left ventricular
systolic and diastolic constitute 6/32 (19%) while 3/15(9%) had left ventricular hypertrophy.
During the study period, a total of 5 patients died after transplant (11.6%). There was no significant
difference in independent variables between survivors and those who died (P value>0.05). There
was no significant difference between ejection fraction (p = 0.5) or shortening fraction (p = 0.4)
pre- to post-transplant, in those who had paired samples (n=6) [using Wilcoxon signed rank test].
Similarly, there was no association between pre-transplant ejection fraction or fractional
shortening and immediate graft functioning or graft rejection (p > 0.1).
Conclusion: Our study showed that close to half of patients who had echocardiographic screening
had abnormality. Left ventricular systolic and diastolic dysfunction were the more common
compared to left ventricular hypertrophy.There was no significant difference between ejection
fraction and fractional shortening on echocardiographic evaluation pre and post-transplant among
6 patients who had paired pre and post-transplant echocardiographic study.
Description
Keywords
Structural and functional cardiac abnormalities, kidney transplant