Echocardiographic Evaluation of Left Ventricular Function and Morpholgy before and after Renal Transplantation in Correlation to Different lmmunosuppressive Protocols

Abstract

Renal transplantation and long term dialysis are the two major forms of treatment for end stage renal failure. However, because successful transplantation replaces all the aspects of renal function, it has been considered to be the treatment of choice for patients with end stage renal disease younger than 60 years of age Among factors influencing long term patient survival, those leading to cardiovascular morbidity and mortality are predominant, so greater attention should paid to the cardiac status of uraemics awaiting renal transplantation. Although, studies suggest that cardiac mortality decreases after renal transplantation (Braun et al., 1981) (Washer et al., 1983), among transplanted patients, the death rate from ischemic heart disease is still high. This may be due to the persistence of hyperlipdaemia secondary to corticosteroids and cyclosporine use and hypertension from chronic rejection or cyclosporine nephrotoxicity (Chapman et al., 1987), which may aggravate coronary artery disease after renal transplantation. As coronary artery disease in uraemics may be asymptomatic secondary to autonomic neuropathy particularly in diabetics (Faerman et al., 1977) (lkram et al., 1983) and since atherosclerotic heart disease is the major cause of death after renal transplantation (Weinrauch et al., 1978) (Bennett et al., 1978), so screening for coronary artery disease is therefore an important aspect of pre transplant evaluation. Also, as the risk of cardiovascular disease and complications increases with age, so all diabetics, and non diabetics over the age of 40, should undergo routine cardiovascular stress testing.