Association of pre-transplant right ventricular function parameters with long-term cardiovascular outcomes following kidney transplantation

The hemodynamic effects of end-stage kidney disease and associated pulmonary hypertension may impair right ventricular (RV) function and influence cardiovascular (CV) outcomes after kidney transplantation (KT). We aimed to evaluate the association between pre-transplant echocardiographic RV function parameters, including RV strain, and long-term CV outcomes following KT. In this retrospective cohort study, we included adult KT recipients at a single Midwest academic center from 2015 to 2024 who had adequate-quality pre-transplant echocardiograms and follow-up at our institution. RV function parameters included tricuspid annular systolic velocity (S'), tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), RV index of myocardial performance (RIMP), and RV free wall strain measured by two-dimensional speckle-tracking echocardiography. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of CV death, non-fatal myocardial infarction, cerebrovascular accident, heart failure hospitalization, coronary revascularization, or sustained ventricular arrhythmias. Among 371 patients (mean age 53.5 ± 13.1 years; 56% male) followed for a median of 4.9 years (IQR, 3.1-6.4), 79 (21.2%) experienced MACE. On univariable Cox analysis, RIMP and RV strain parameters were associated with MACE, whereas S', TAPSE, and FAC were not. Kaplan-Meier analysis showed lower MACE-free survival in patients with abnormal mid and apical RV strain, whereas the basal and dichotomized average-strain comparisons were not significant. In multivariable models, only average, mid, and apical RV strain remained independently associated with MACE. Pre-transplant RV strain was independently associated with long-term MACE after KT and may aid CV risk stratification. Further studies are needed to validate these findings.