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Yonsei Med J. 2019 Mar;60(3):291-297. doi: 10.3349/ymj.2019.60.3.291.

The Impact of Perioperative Factors on Changes in Diastolic Function after Kidney Transplantation: A Retrospective Analysis.

Kim EJ1,2, Koo BN1,2, Kim SY1,2, Huh KH3, Kang S1, Choi YS1,4.

Author information

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 Transplantation Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
4
Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea. YSCHOI@yuhs.ac.

Abstract

PURPOSE:

Cardiac changes in end-stage renal disease are the most common causes of death after kidney transplantation (KT). Chronic kidney disease presents a major risk factor for the development and progression of diastolic dysfunction. The purpose of this study was to identify the association between changes in left ventricular (LV) diastolic function and perioperative clinical factors in patients with preserved ejection fraction following KT.

MATERIALS AND METHODS:

We reviewed 115 patients who underwent KT between January 2011 and December 2015 with both preand post-transplant echocardiograms; patients with LV systolic dysfunction were excluded. LV diastolic function was measured using the ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e').

RESULTS:

Patients with normal pre-operative LV systolic function (n=97) showed improvement in E/e' after KT (11.9±4.4 to 10.5±3.8, p=0.023). Additionally, post-KT estimated glomerular filtration ratio was associated with changes in E/e' (odds ratio, -0.056; 95% confidence interval, -0.014 to -0.007; p=0.026). Among patients with preexisting diastolic dysfunction (20/97 patients), the amount of intraoperative fluid administration was related to E/e' changes (odds ratio, 0.003; 95% confidence interval, 0.000 to 0.005; p=0.029).

CONCLUSION:

KT is associated with improved diastolic function. Post-KT renal function was significantly related to changes in LV diastolic function. The amount of intraoperative fluid was a risk factor for worsening diastolic function after KT in patients with preexisting diastolic dysfunction.

KEYWORDS:

Kidney transplantation; diastolic function; end-stage renal disease (ESRD)

PMID:
30799592
PMCID:
PMC6391522
DOI:
10.3349/ymj.2019.60.3.291
[Indexed for MEDLINE]
Free PMC Article

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