Abstract 18195: Prognostic Significance of Diastolic Dysfunction in Patients With Normal Ejection Fraction who are Undergoing Kidney Transplantation

Introduction: Diastolic dysfunction is frequently impaired in patients with ESRD. Our study aimed to determine whether diastolic dysfunction and echo parameters could predict mortality among kidney transplant (KT) patients who had normal pre-transplantation EF. Methods: We retrospectively enrolled 703 patients with normal EF who underwent a KT at our institution from 2005-2015. Diastolic parameters including diastolic grade, left ventricular end diastolic and systolic volumes (LVEDD, LVESD), septal and posterior wall thickness, mitral E-wave, A-wave and E/A ratio were available in 381 patients with preoperative echocardiograms. Demographic and survival data were obtained from medical records. Mann-Whitney, chi-square, ROC and Kaplan-Meier (KM) analyses were performed. Results: Patients were followed up for a median duration of 3 years (IQR 1-5.4) during which period 45 deaths were recorded. The mean EF of the cohort was 62%. Except for higher LVEDD (5.3 cm vs 4.9 cm, p=0.02) and LVESD (3.7 cm vs 3.3 cm, p=0.029) in expired patients, there was no statistical difference in the aforementioned parameters between survivors and non-survivors. ROC analysis showed cut-off points for LVEDD of 5.1 cm (sen 83%, sp 57%, AUC 0.7) and LVESD of 3.4 cm (sen 83%, sp 56%, AUC 0.7). Stratification based on these points revealed a higher mortality in patients with LVEDD greater than 5.1 cm (9.9% vs 1.6%, p=0.006) and LVESD greater than 3.4 cm(9.9% vs 1.7%, p=0.007). KM analyses confirmed these findings (Figure 1A/B). Conclusions: Although diastolic grade and other parameters were not predictive of survival post KT, LVEDD and LVESD were statistically significant predictors of post-transplant survival. Our findings suggest that a dilated left ventricle portends a poor prognosis in KT. These easy-to-measure echocardiographic parameters can be used to risk-stratify patients with preserved EF who are undergoing KT.