Usually co -morbid conditions are relative contraindication for renal transplantation . LV Myocardial dysfunction is a fairly common association in CKD.
The uniqueness of this LV dsyfunction is , there is no primary myocardial failure . Further features observed are . . .
- Structural damage is less
- LV is not much dilated
- Wall thinning is less common , In fact more often than not LVH is associated . (Laplace law at work to reduce LV wall stress !)
- The systemic Blood pressure is well maintained (Chronic HT related ?)
Mechanism of reversible LV dysfunction in CKD
Chronic pressure overload result in After load mismatch .
(Normally pre-load , after load , and contractility should be sequentially matching parameters . After load mismatch is an important concept where myocardial contractility is temporarily is depressed due to lack of adequate pre-load for a given level of after load )
Evidence for reversibility
Very often one can observe improvement of LV function significantly 24 hours after dialysis .The concept of uremic biochemical dysfunction is still valid .Though it can not be exactly quantified .
If significant coronary artery disease is excluded , these patients do well ( after transplantation ) from a cardiac point of view !
(64 slice MDCT may be a simple screening test to rule our significant CAD .)
How wise it is to do renal transplantation in DCM patients ? .
- Most patients with LV dysfunction of CKD do well after transplantation .
- Presence of severe LV dysfunction especially with normal or increased wall thickness should not be a contraindication to renal transplantation .