Studies on structural changes of the carotid arteries and the heart in asymptomatic renal transplant recipients

Background. The present study was designed to characterize early structural changes of large arteries in renal transplant recipients with no clinical evidence of cardiovascular disease and normal blood pressure values, and to analyse the relationship between arterial alterations and those of the heart. Methods. Intima-media thickness and atherosclerotic plaques of the carotid arteries as well as left ventricular geometry and function were examined in 35 asymtomatic renal transplant recipients and 29 age- and sex-matched healthy controls by high resolution B-mode ultrasound and by echocardiography. Results. Intima-media thickness of the carotid arteries was significantly higher in renal transplant recipients (1.21 +/- 0.08 mm) than in healthy controls (0.74 +/- 0.04 mm) (P < 0.001). Atherosclerotic plaques were found in the majority of renal transplant recipients (71% vs 14% in healthy controls, P < 0.001). Left ventricular mass index was significantly increased in the group of renal transplant recipients (264 +/- 13 g, 146 +/- 7 g/m(2)) when compared with healthy controls (155 +/- 8 g, 83 +/- 4 g/m(2)) (P < 0.001). Multiple regression analysis in renal transplant recipients showed that intima-media thickness of the carotid arteries was significantly related to left ventricular mass index (P < 0.02), but not to age, blood pressure, body mass index, serum creatinine, cholesterol and lipoprotein (a) levels. In the group of healthy controls, intima-media thickness of the carotid artery was related to age (P < 0.002), but not to left ventricular mass index or the other independent variables. Conclusions. The present study documents pronounced intima-media thickening in asymptomatic renal transplant recipients. Atherosclerotic lesions are present in most renal transplant recipients with no clinical evidence of cardiovascular disease. We observed a parallelism between arterial wall thickening and left ventricular hypertrophy, although blood pressure levels were normal during haemodialysis therapy and after renal transplantation.