Cardiovascular effects of successful renal transplantation: a 1-year sequential study of left ventricular morphology and function, and 24-hour blood pressure profile.

Background: Cardiovascular disease is the leading cause of death in renal transplant recipients. The purpose of this study was to determine the effects of a successful renal transplantation on left ventricular morphology and function and on the 24-hr blood pressure profile.

Methods: Twenty-four patients with end-stage renal disease were prospectively studied by ambulatory blood pressure monitoring and echocardiography before and at 3, 6, and 12 months after renal transplantation. Patients were also analyzed according to their renal function after transplantation.

Results: We observed a significant drop in the mean values of daytime and nocturnal systolic blood pressure and in the 24-hr systolic pressure load at 12 months after transplantation. The most frequent echocardiographic finding was left ventricular hypertrophy (LVH), for which the incidence decreased from 75% before transplantation to 52.1% at 12 months after transplantation (P = 0.125). There was a significant decrease in left ventricular dilatation, and systolic dysfunction normalized in all patients after 12 months. The variables that best independently predicted the decrease in LVH were serum creatinine levels and the 24-hr systolic pressure load as registered by ambulatory blood pressure monitoring at 12 months after transplantation. We observed significant decreases in left ventricular mass and left ventricular mass index in the group of patients who had adequate renal function, as compared with no changes in patients who did not.

Conclusions: Correction of the uremic state by renal transplantation leads to complete resolution of systolic dysfunction, regression of LVH, and improvement of left ventricular dilatation. In fact the reduction of LVH was dependent on adequate renal function and on a decrease in the systolic pressure levels.