High Left Ventricular Filling Pressure on Doppler Echocardiography Is Associated With Graft Failure and Overall Mortality Following Kidney Transplantation

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• 作者：Ji-Yeon Bang ; MD ; PhD^* ; Jung Bok Lee ; PhD^&dagger ; ; Bo-Hyun Sang ; MD^* ; Young Hoon Kim ; MD ; PhD^&Dagger ; ; Duck Jong Han ; MD ; PhD^&Dagger ; ; Jun-Gol Song ; MD ; PhD^* ; ^{jungol.song@amc.seoul.kr" class="auth_mail" title="E-mail the corresponding author} ; Gyu-Sam Hwang ; MD ; PhD^*
• 关键词：end-stage renal disease ; kidney transplantation ; left ventricular filling pressure ; Doppler echocardiography
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：30
• 期：3
• 页码：585-591
• 全文大小：383 K

文摘

Although E/e´ is prognostic of mortality in patients with end-stage renal disease (ESED), little is known about the prognostic implications of E/e´ following kidney transplant (KT). The objective of this study was to evaluate whether an elevated E/e´ is associated with graft function, postoperative hemodialysis, and overall mortality in end-stage renal disease patients following KT.

Design

A retrospective observational study.

Setting

Tertiary teaching hospital.

Participants

In total, 1,045 patients underwent KT at the authors’ hospital between January 2006 and December 2013.

Intervention

None.

Measurements and Main Results

Patients were divided into groups with an E/e´<15 or≥15, as assessed by preoperative echocardiography (median time from preoperative assessment of echocardiography to surgery: 37 days [IQR: 16-68 days]). Of 1,045 patients, 821 patients (78.6%) had an E/e´<15, and 224 patients (21.4%) had an E/e´≥15. Multivariate analysis indicated that age (odds ratio [OR]: 1.03; 95% confidence interval [CI]: 1.01-1.04, p = 0.001), diabetes mellitus (OR: 2.7; CI: 1.94-3.83, p<0.001), β-blocker (OR: 1.4; CI: 1.03-1.95, p = 0.034), left atrial dimension (OR: 1.07; CI: 1.04-1.11, p<0.001), and left ventricular mass index (OR: 1.02; CI: 1.01-1.03, p<0.001) are predictive of E/e´≥15. After adjustment using inverse probability of treatment weighting, E/e´≥15 also was associated independently with postoperative hemodialysis (OR: 2.0; 95% CI: 1.5–2.6, p<0.001), graft failure (OR: 1.7; 95% CI: 1.4-2.2; p<0.001), and overall mortality (hazard ratio [HR]: 3.2; 95% CI: 2.1-4.8, p<0.001).

Conclusions

Preoperative E/e´ is a prognostic indicator of overall mortality in ESRD patients undergoing KT.