Long-term impact of renal transplantation on carotid artery properties and on ventricular hypertrophy in end-stage renal failure patients

Background. The aim of this study was to examine prospectively the impact of renal transplantation on the morphological and functional characteristics of the carotid arteries and heart in a group of end-stage renal failure patients without overt cardiovascular disease, followed up for >3 years. Methods. Twenty-two patients were evaluated 2-3 weeks after renal transplantation, and again 12 and 40 months post-transplant, using high resolution ultrasound imaging and echocardiography. Results. Kidney and patient survival were 100% at the end of follow-up without any major cardiovascular events. After 40 +/- 1.2 months, carotid morphological parameters were normalized: carotid intima-media thickness fell from 788 +/- 24 to 676 +/- 32 mum (P<0.01) and the carotid wall/lumen ratio fell from 118 +/- 3 to 103 +/- 3 mu m (P<0.01). Significant reduction of left ventricular (LV) posterior wall thickness (11.5 +/- 0.2 to 11.3 +/- 0.2 mm, P<0.05) and LV mass index (172 +/- 9 to 158 +/- 8 g/m(2), P<0.01) was already observed after 12 +/- 0.2 months. Further reduction of LV posterior wall thickness (10.4 +/- 0.3 mm, P<0.01) and of LV mass index (136 +/- 7 g/m(2), P<0.01) also occurred after 40 +/- 1.2 months. However, carotid distensibility (19.5 +/- 2.1 vs 22 +/- 2.4, not significant (NS)) and LV compliance (early to atrial flow ratio: 1.2 +/- 0.1 vs 1.3 +/- 0.1, NS) remained abnormal, and normalization of the LV mass was attained by only 25% of the patients with LV hypertrophy on baseline. Multiple stepwise regression analysis showed that the rate of change of reduction of the intima-media thickness was influenced by age (negative association, P<0.001) and was positively related to white race (P<0.05), female sex (P<0.01) and to the parallel reduction of maximum carotid diameter (P<0.001). Reduction of LV mass index over time was negatively related to the duration of dialysis treatment and to the parallel increase observed in body mass index and haematocrit, and was positively related to the simultaneous reduction of diastolic blood pressure (P<0.01 for all variables). Conclusions. Successful renal transplantation improves but does not cause complete regression of the cardiovascular alterations of end-stage renal disease. Only intima-media thickness was normalized by transplantation, whereas LVMI and carotid and ventricular distensibility remained abnormal. The results suggest that extended duration of dialysis, weight gain, high blood pressure and high haematocrit may adversely affect the rate of change of post-transplant cardiovascular hypertrophy.