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Improvement of Cardiac Sympathetic Innervation by Renal Transplantation

¹ Department of Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
² Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan

Chronic renal failure (CRF) patients on dialysis frequently show reduced heart rate variability (HRV), which has been reported to be corrected by renal transplantation. Recently, ¹²³I-metaiodobenzylguanidine (¹²³I-MIBG) scintigraphy has been used to evaluate cardiac sympathetic innervation, and uremic patients often show marked abnormalities of cardiac ¹²³I-MIBG uptake. We investigated whether renal transplantation can improve cardiac ¹²³I-MIBG uptake in patients with CRF on dialysis. Methods: We analyzed time- and frequency-domain measures of 24-h HRV and cardiac ¹²³I-MIBG scintigraphy before and 1–3 mo after renal transplantation in 13 CRF patients on dialysis and in 10 control subjects. Results: Both 24-h HRV and cardiac ¹²³I-MIBG uptake were significantly abnormal in the patients before transplantation compared with the control subjects. After transplantation, ¹²³I-MIBG washout rate from the myocardium significantly decreased from 46% ± 21% to 20% ± 22% (P = 0.006), and the heart-to-mediastinum ratio of ¹²³I-MIBG uptake in the late image significantly increased from 1.74 ± 0.39 to 2.06 ± 0.39 (P = 0.006). On the other hand, HRV measures tended to increase after transplantation but the changes did not reach statistical significance (P > 0.05). Conclusion: Renal transplantation provides the improvement of uremic cardiac sympathetic neuropathy assessed by ¹²³I-MIBG imaging, which may be a more sensitive or at least an earlier marker than HRV.

Key Words: kidney transplantation • metaiodobenzylguanidine • heart rate variability • sympathetic nervous system • autonomic nervous system

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