Changes in echocardiographic indices following kidney transplantation: a systematic review and meta-analysis

Objective: Cardiovascular disease is the leading cause of death in ESKD and uremic cardiomyopathy contributes significantly to the increased cardiovascular risk in these patients. Kidney transplantation is associated with improved survival compared to dialysis. This systematic review and meta-analysis (CRD42022371202) aims to assess the changes in echocardiographic indices in patients before and following kidney transplantation Design and method: We included studies in adult subjects with echocardiographic assessments before (baseline) and following kidney transplantation (>1 month follow-up). The primary outcome measure was left-ventricular mass index (LVMI). Literature search involved PubMed, Web-of-Science and Scopus databases, manual search of article references and grey literature. Results: From 6463 records initially retrieved, 35 studies with a total of 2692 participants were included in the final quantitative meta-analysis. From 30 studies (2211 patients) reporting the primary outcome, LVMI was significantly decreased after kidney transplantation compared to pre-transplantation values [WMD -21.16 g/m 2 , 95%CI(-27.21, -15.12), I2 = 88%, P < 0.001]. In subgroup analysis, higher differences were evident among 6 studies (N = 163) evaluating LVMI < 6 months after kidney transplantation [WMD -41.54 g/m 2 , 95%CI (-51.31, -31.78), I2 = 13%, P < 0.001] and lower differences among 24 studies (N = 2048) evaluating LVMI >6 months after kidney transplantation [WMD -16.64 g/m 2 , 95%CI(-22.79, -10.49), I2 = 88%, P < 0.001]. In sensitivity analyses, patients receiving kidney from living kidney donors (WMD; -76.90 g/m 2 , 95%CI (-122.13, -31.67), I2 = 88%, P < 0.001) and those on hemodialysis before KTx [WMD;-33.76 g/m 2 , 95%CI (-51.51, -16.00), I2 = 92% P < 0.001] presented higher LVMI reductions following transplantation. Conclusions: Kidney transplantation is associated with significant reductions in LVMI compared to the pre-transplantation levels. This could be another factor contributing to the lower cardiovascular risk observed in KTRs compared to dialysis patients