Introduction: The prevalence of pulmonary hypertension (PHTN) among end stage renal disease (ESRD) patients on hemodialysis is approximately 40-50%. Right heart catheterization is the gold standard for diagnosis of PHTN; however, transthoracic echocardiography (TTE) is often used as a non-invasive screening tool. In this study, we evaluated whether echocardiographic indicators of PHTN, including right ventricular (RV) size and function, are predictive of graft failure and all-cause mortality.

Methods: A retrospective review of adult deceased donor renal transplant recipients from Jan 2008 to June 2010 was conducted. Patients with a TTE within one year prior to transplant were included. TTE images were evaluated and measured by a blinded expert echocardiographer. The primary endpoint was a composite of all-cause death, graft failure, and delayed graft function.

Results: Recipients (N=80) were adults, ages 19-75 (mean age=51 years; 60 males). RV basal diameter, measured in the apical 4-chamber view, was significantly larger in patients who met the primary endpoint (mean=41 vs 37 mm, P=0.02). Time on dialysis (P=0.02) and hypotension at the time of transplant (P=0.04) were significantly associated with a higher risk of the primary endpoint; the association of left atrial diameter with outcomes was of borderline significance (P=0.05). All 7 patients with qualitative RV dysfunction met the primary endpoint, such that RV dysfunction was significantly predictive of outcomes (P=0.016). In a multivariate model adjusting for blood pressure, time on dialysis, left atrial diameter, RV basal diameter, and qualitative RV dysfunction, neither RV parameter was independently associated with outcomes. Notably, RV systolic pressure (RVSP) based on tricuspid regurgitation velocity was unmeasurable in 44/80 (55%) patients, with the RVSP in the remaining patients not predictive of outcomes.

Conclusions: RV basal diameter and qualitative RV dysfunction are associated with adverse outcomes in the renal transplant population. RVSP was unmeasurable in majority of patients in this study, underscoring the poor sensitivity of using this parameter as a surrogate marker for PHTN. Non-invasive assessment of RV size and function by TTE is feasible within the ESRD population and should be strongly considered as a standard part of the pre-transplant cardiovascular risk assessment.

CITATION INFORMATION: Tinney Jr F, Lazar S, Naik A, Samaniego-Picota M, Bhave N. Detection of Right Ventricular Dilation and Dysfunction by Transthoracic Echocardiography Predicts Renal Transplant Outcomes. Am J Transplant. 2017;17 (suppl 3).

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