Heart failure & cardiomyopathies
Distinct prognostic trajectories of heart failure phenotypes following kidney transplantation
Main finding · HF hospitalizationResult — go to the resultAdjusted hazard ratio 9.57 95% CI 3.37–27.2Authors' conclusion
Post-KT trajectories differ by pre-transplant HF phenotype. Uraemic HFpEF is a persistent, non-reversible phenotype driving severe post-KT morbidity. HFrEF demonstrates systolic reversibility. Pre-transplant evaluation should incorporate targeted diastolic profiling beyond standard LVEF-centred assessment to identify KT candidates at high risk for recurrent post-transplant HF morbidity.
Study context
- Population
- Adult KT recipients stratified by pre-transplant echocardiographyHFpEF 64 (14.5%) · HF with reduced ejection fraction (HFrEF) 44 (10.0%) · controls 334 (75.5%)
- Participants
- 442 recipients
- Exposure
- HFpEF and HFrEF vs controls, by pre-transplant echocardiography
- HFpEFn = 64
- HFrEFn = 44
- Controlsn = 334reference
- Outcome
- Heart failure (HF) hospitalization
- Follow-up
- 49-month median
Main finding
As reported in the abstract
Adjusted hazard ratio
9.57
95% CI 3.37–27.2
P < 0.001
HFpEFvs controls
aHR 9.57 (95% CI 3.37–27.2); P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| Composite death/HF hospitalization · 49-month median follow-upHFpEFvs controls | 4.46 (2.36–8.42) | P < 0.001 | |
| All-cause mortalityHFrEFvs controls | 2.9 (1.16–7.25) | P = 0.023 | |
| HF hospitalization (HFrEF)HFrEFvs controls | 3.11 (0.71–13.6) | P = 0.13 | |
| HF hospitalization per ΔLVEFLower HF hospitalization risk | 0.94 (0.90–0.99) | P = 0.02 | |
| Mortality per continuous changes in haemoglobin and calciumHaemoglobin | 0.71 (0.60–0.83) | P < 0.001 | |
| Mortality per continuous changes in haemoglobin and calciumCalcium | 0.69 (0.50–0.96) | P = 0.027 | |
| 0.050.21520Adjusted hazard ratio (log scale) |
E/e' (paired longitudinal echocardiography, HFpEF group)
- E/e' change
- 12.7 ± 4.6 to 11.8 ± 5.3
- P
- P = 0.117
- Persistent diastolic stiffness
ΔLVEF (HFrEF)
- ΔLVEF
- +8.7 ± 10.2%
- P
- P = 0.003
- Systolic recovery
Original publication
Distinct prognostic trajectories of heart failure phenotypes following kidney transplantation. ESC Heart Fail. Published 20 August 2026. doi:10.
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