#2578 Evaluation of the relationship between post-transplant graft elastographic findings and cardiac strain in renal transplant patients

Abstract Background and Aims The aim of this study was to detect cardiac fibrosis that may develop with renal fibrosis in transplant patients by shear wave elastography and echocardiography, which are non-invasive, easy to apply, inexpensive and easily reproducible methods. Strain represents the contractility of a myocardial segment relative to its original size and is expressed as a percentage. In individuals with heart failure with preserved ejection fraction (HFpEF), many echocardiographic and laboratory markers appear normal in the early stages. However, with speckle tracking echocardiography (STE), left and right ventricular global longitudinal strain(LV/RV GLS), right ventricular free wall strain(RV FWS), and left atrial strain(SR) have been shown to indicate diastolic dysfunction. Early detection of renal fibrosis can facilitate treatment at an earlier stage. While the gold standard for detecting renal fibrosis is renal biopsy, its invasive nature, the potential for complications, and high cost have led to a greater focus on noninvasive techniques. Among these techniques, ultrasound is the most widely used due to its practicality, low cost, and effectiveness in early evaluation and long-term follow-up of kidney grafts in the post-transplant period. Shear wave elastography (SWE), available in the latest ultrasound devices, applies acoustic radiation force to tissues at high power (2.67 MHz frequency) and short duration (0.03–0.4 ms) via ultrasound probes instead of external compression. In the SWE method, tissue stiffness is measured using the Young's modulus of elasticity and expressed in kilopascals (kPa). Method The study is a single-center, cross-sectional and prospective study. Using STE, strain parameters such as LV/RV GLS, RV FWS, and SR values were evaluated before transplantation, at the 6th month after transplantation, and at the 12th month after transplantation. Additionally, left atrial volumes can also be measured with STE. In elastographic evaluations, kPa values were assessed at the 1st week, the 6th month, and the 12th month post-transplantation. The collected data were compared over time, aiming to indirectly reach conclusions. Results According to pre-transplant echocardiographic parameters, none of the patients were found to have diastolic dysfunction. Similarly, when evaluated based on post-transplant echocardiographic parameters, no patients were identified with diastolic dysfunction at the 6th or 12th month. LV GLS, RV GLS and RV FWS values decreased at 6 months and 12 months after transplantation compared to pre-transplantation, but statistical significance was not found (p: 0.091, p: 0.368, p: 0.368, respectively). In addition, kPa values increased during the process, but again no statistical significance was found (p: 0.074). Descriptive analyses of elastographic and strain parameters are given in Appendix-1 and Appendix-2. When the follow-up of strain parameters was analyzed, only RV GLS values showed a statistically significant recovery at 12 months post-transplantation compared to pre-transplantation (p: 0.028). Conclusion Despite the narrow sampling and limited follow-up period, the statistically significant recovery in right ventricular GLS values and the clinically significant but not statistically significant increase in kPa values are remarkable.