ArticleESC heart failure2026
Distinct prognostic trajectories of heart failure phenotypes following kidney transplantation.
Article in ESC heart failure, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
BACKGROUND AND
aimsHeart failure (HF) drives post-kidney transplant (KT) morbidity. While KT reverses components of uraemic cardiomyopathy, the persistence of post-transplant risk in HF with preserved (HFpEF) versus HF with reduced ejection fraction (HFrEF) remains unclear. We evaluated phenotype-specific remodelling and clinical outcomes.
methodsRetrospective cohort of adult KT recipients stratified by pre-transplant echocardiography: HFpEF (left ventricular ejection fraction [LVEF] ≥50% with elevated filling pressures), HFrEF (LVEF <50%), or controls. Longitudinal echocardiographic remodelling and post-transplant outcomes were analysed using multivariable Cox regression.
resultsOf 442 recipients, 64 (14.5%) had HFpEF, 44 (10.0%) HFrEF, and 334 (75.5%) controls. Over a 49-month median follow-up, HFpEF was independently associated with HF hospitalization (adjusted hazard ratio [aHR] 9.57; 95% confidence interval [CI] 3.37-27.2, P < .001) and composite death/HF hospitalization (aHR 4.46; 95% CI 2.36-8.42, P < .001). Paired longitudinal echocardiography demonstrated persistent diastolic stiffness within the HFpEF group (E/e': 12.7 ± 4.6 to 11.8 ± 5.3, P = .117). Conversely, HFrEF patients exhibited systolic recovery (ΔLVEF +8.7 ± 10.2%, P = .003), remaining independently associated with all-cause mortality (aHR 2.9; 95% CI 1.16-7.25, P = .023) but not HF hospitalization (aHR 3.11; 95% CI 0.71-13.6, P = .13). Mechanistically, ΔLVEF predicted lower HF hospitalization risk (aHR 0.94; 95% CI 0.90-0.99, P = .02), whereas mortality tracked with continuous changes in haemoglobin (aHR 0.71; 95% CI 0.60-0.83, P < .001) and calcium (aHR 0.69; 95% CI 0.50-0.96, P = .027).
conclusionsPost-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.
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