Cardiovascular Outcomes in Kidney Transplant Recipients With ADPKD

Maroun Chedid; Hasan-Daniel Kaidbay; Stijn Wigerinck; Yaman Mkhaimer; Byron Smith; Dalia Zubidat; Imranjot Sekhon; Reddy Prajwal; Parikshit Duriseti; Naim Issa; Ziad M Zoghby; Christian Hanna; Sarah R Senum; Peter C Harris; LaTonya J Hickson; Vicente E Torres; Vuyisile T Nkomo; Fouad T Chebib

doi:10.1016/j.ekir.2022.06.006

Cardiovascular Outcomes in Kidney Transplant Recipients With ADPKD

Kidney Int Rep. 2022 Jun 11;7(9):1991-2005. doi: 10.1016/j.ekir.2022.06.006. eCollection 2022 Sep.

Authors

Maroun Chedid¹, Hasan-Daniel Kaidbay^{1

2}, Stijn Wigerinck¹, Yaman Mkhaimer¹, Byron Smith³, Dalia Zubidat¹, Imranjot Sekhon¹, Reddy Prajwal⁴, Parikshit Duriseti¹, Naim Issa^{1

5}, Ziad M Zoghby¹, Christian Hanna^{1

6}, Sarah R Senum¹, Peter C Harris^{1

7}, LaTonya J Hickson⁸, Vicente E Torres¹, Vuyisile T Nkomo⁴, Fouad T Chebib⁸

Affiliations

¹ Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
² Lebanese American University, Gilbert and Rose-Mary Chagoury school of medicine, Byblos, Lebanon.
³ Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.
⁴ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁵ William J Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Division of Pediatric Nephrology and Hypertension, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁷ Department of biochemistry and molecular biology, Mayo Clinic, Rochester, Minnesota, USA.
⁸ Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA.

Abstract

Introduction: Cardiovascular disease leads to high morbidity and mortality in patients with kidney failure. Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a systemic disease with various cardiac abnormalities. Details on the cardiovascular profile of patients with ADPKD who are undergoing kidney transplantation (KT) and its progression are limited.

Methods: Echocardiographic data within 2 years before KT (1993-2020), and major adverse cardiovascular events (MACEs) after transplantation were retrieved. The primary outcome is to assess cardiovascular abnormalities on echocardiography at the time of transplantation in ADPKD as compared with patients without ADPKD matched by sex (male, 59.4%) and age at transplantation (57.2 ± 8.8 years).

Results: Compared with diabetic nephropathy (DN, n = 271) and nondiabetic, patients without ADPKD (NDNA) (n = 271) at the time of KT, patients with ADPKD (n = 271) had lower rates of left ventricular hypertrophy (LVH) (39.4% vs. 66.4% vs. 48.6%), mitral (2.7% vs. 6.3% vs. 7.45) and tricuspid regurgitations (1.8% vs. 6.6% vs. 7.2%). Patients with ADPKD had less diastolic (25.3%) and systolic (5.6%) dysfunction at time of transplantation. Patients with ADPKD had the most favorable post-transplantation survival (median 18.7 years vs. 12.0 for diabetic nephropathy [DN] and 13.8 years for nondiabetic non-ADPKD [NDNA]; P < 0.01) and the most favorable MACE-free survival rate (hazard ratio = 0.51, P < 0.001). Patients with ADPKD had worsening of their valvular function and an increase in the sinus of Valsalva diameter post-transplantation (38.2 vs. 39.9 mm, P < 0.01).

Conclusion: ADPKD transplant recipients have the most favorable cardiac profile pretransplantation with better patient survival and MACE-free survival rates but worsening valvular function and increasing sinus of Valsalva diameter, as compared with patients with other kidney diseases.

Keywords: ADPKD; MACE; cardiovascular outcome; echocardiogram; kidney transplantation; valvular disease.

Grants and funding

R01 DK058816/DK/NIDDK NIH HHS/United States