Introduction: In CKD patients Cardiac disorders like left ventricular hypertrophy (LVH), left ventricle (LV) dilatation,  reduced LV fractional shortening and diastolic dysfunction are very common. These cardiac abnormalities continues to progress as CKD progresses even in the first year of dialysis. We planned a study to evaluate echocardiographic changes in CKD stage 5 patients after renal transplantation by periodic echocardiographic parameters measurement in  pre and post   transplantation period in Indian population.

Methods: 51 consecutive renal transplant recipients ( 37 males,14 females), undergoing live donor renal transplantation were taken in the study after written consent. Four  echocardiographic parameters were assessed ie, 1) Left ventricular ejection fraction(LVEF), 2) Grade of diastolic dysfunction, 3) Left ventricular wall thickness and 4) Left ventricular end diastolic diameter,  both pre-transplant and post-transplant. The post-transplant echocardiographic evaluation was done between 6 to 18 months of transplantation. Besides the clinical parameters , the biochemical parameters, immunosuppressives and other medication requirements were recorded.

Observation: Pre Tx (Transplant) average systolic BP of 147.05±14.32 mm Hg improved in Post Tx period to 126.67±18.07 with P value- < 0.0001. Pre Tx average diastolic BP was 89.41±7.85 mm Hg which also improved in Post Tx period to 76.67±11.07 (P value- <0.0001). Average pre Tx LVEF was found to be 60.74±7.26%. In post Tx period, it improved significantly to 65.02±4.31%, (p value  < 0.0001). An increasement of LVEF ≥ 5% of pre-Tx level was considered to be significant improvement in this study. All 11(100%)  patients with pre transplant LVEF < 54% , showed  ≥ 5% improvement in LVEF post transplantation. We also noticed that patients with pre Tx normal LVEF(> 55%), but BP uncontrolled, after transplantation, were trending towards lower improvement of LVEF than those with BP controlled. Of 44 patients, having some grades of diastolic dysfunctions pre-Tx, 21 patients( 47.7%) had improvement whereas 18 patients( 40.90%) had no improvement and 5 patients( 11.36%) had further diastolic functions deterioration. In this study, average interventricular wall thickness was 1.22±0.18 cms in pre Tx assessment and it decreased to 1.15±0.15 cms in post Tx period ( p value= 0.01). Similarly, average pre Tx LV posterior. wall thickness of 1.19±0.18 cms was reduced in post Tx period to 1.14±0.14 cms ( P value = 0.027).Average pre Tx LVEDD was found to be 4.9± 0.52 cms and in post Tx was 4.47± 0.42 cms. Thus it  improved after transplantation significantly (p value-<0.0001).

Conclusion: Our study suggests Kidney transplantation brings in  significant improvement in Systolic BP, Diastolic BP, IVS wall thickness, LV Posterior wall thickness, LV Ejection Fraction, LV End diastolic diameter and LV diastolic function post renal transplantation.