Pre‐Transplant Left Atrial Volume Index and One‐Year Morbidity After Kidney Transplantation
Sajid Kadir, Andres Pelaez, Sandeep Sasidharan, Ronald ZoltyABSTRACT
Objectives
Pre‐transplant echocardiography is routinely performed in kidney transplant candidates, although it remains unclear which parameters are associated with the broad spectrum of post‐transplant complications beyond cardiovascular events. Left atrial volume index (LAVI) reflects chronic diastolic burden, and its relationship with overall post‐transplant morbidity has not been well defined.
Material and Methods
In a single‐center retrospective cohort of 242 adults undergoing first kidney‐only transplantation (2020 to 2022) with pre‐transplant echocardiography within 12 months, the main outcome was a composite of one‐year post‐transplant complications. Multivariable logistic regression was adjusted for age, sex, BMI, diabetes, and deceased donor status.
Results
LAVI was abnormal (>34 mL/m 2 ) in 83 of 218 patients (38.1%), with largely preserved systolic function (mean LVEF 59.1 ± 6.2%). Abnormal LAVI was associated with the composite outcome (69.5% versus 53.2%, adjusted OR 2.01, 95% CI 1.08 to 3.73, p = 0.027), with a graded increase across tertiles (trend p = 0.030). No individual complication category reached significance. Excluding cardiac events, the non‐cardiac composite was similar in magnitude but not conventionally significant (adjusted OR 1.80, 95% CI 0.98 to 3.32). No other echocardiographic parameter was associated with the outcomes. Atrial fibrillation analyses were exploratory and should be interpreted cautiously.
Conclusions
Pre‐transplant LAVI >34 mL/m 2 was associated with a higher burden of one‐year post‐transplant morbidity, with a graded relationship across severity. No individual complication category reached significance. These findings are hypothesis‐generating and require prospective validation before clinical use.