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Kidney Week

Abstract: PO2510

Mitral Regurgitation and Aortic Stenosis After Kidney Transplantation

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Kyeso, Yousuf, Johns Hopkins Hospital, Baltimore, Maryland, United States
  • Abbas, Hashim, Johns Hopkins Hospital, Baltimore, Maryland, United States
  • Brennan, Daniel C., Johns Hopkins Hospital, Baltimore, Maryland, United States
  • Alasfar, Sami, Johns Hopkins Hospital, Baltimore, Maryland, United States
Background

Valvular heart disease (VHD) is highly prevalent in patients with end stage kidney disease and has been associated with poor outcomes. The 5-year mortality rate among patients with at least mild aortic stenosis (AS) or mitral regurgitation (MR) is more than 50% greater than in persons without kidney disease (Samad et al, JAHA 2017). Current knowledge of VHD in patients after kidney transplantation (KT) is scarce.

Methods

This is an ongoing single center retrospective study. In our center, all KT recipients have echocardiograms within one year prior to KT. We included KT recipients at our institution between Jan 2016 and Dec 2016 who had underlying MR and/or AS of any severity. Participants had to have an echocardiogram (Echo) around one year post KT. Our primary objective was to compare the severity of MR and AS at one year post KT to the baseline severity. The secondary objective was to describe changes in left ventricle hypertrophy (LVH).

Results

Two hundred subjects were initially screened. The number of patients who met our inclusion criteria was 22 (Table 1). Mild MR was present in 10 recipients pre KT. MR improved in 4, remained stable in 4, and worsened in 2 out of these 10 recipients at one year post KT. Moderate MR was present in 7 recipients pre KT and all 7 had improvement in severity of MR at one year post KT. Two and three recipients had mild AS and moderate AS respectively pre KT and all of them were observed to have worsening of aortic valve area (AVA) at one year post KT (mean AVA 1.96 versus 1.15 cm2, p 0.07). Nine out of the total 22 recipients included had mild LVH pre KT and all the 9 continued to have mild LVH post KT.

Conclusion

Our study showed that most KT recipients with pre-existing MR had improvement in the severity of MR at one year post KT. However, recipients with AS prior to KT were observed to have worsening in severity of AS at one year post KT. Larger studies are needed to confirm these findings and identify factors that influence progression.

Table 1. Clinical Characteristics
Mean age (yr)(64)
GenderMale (14)
Female (8)
RaceNon white (9)
White (13)
Cause of CKDDiabetes (4)
Hypertension (5)
Liver disease (3)
FSGS (2)
Other (8)
Source of organDiseased (17)
Living (5)
Delayed graft functionYes (17)
No (5)
Dialysis modalityHD (18)
PD (4)