LAUSR

We have read with great interest the article titled “Improvement in cardiac function after renal transplantation in four patients with severe left ventricular systolic dysfunction,” which was written by Aslanger et al.1 Authors evaluated preoperative and postoperative echocardiographic results including improvement of systolic and diastolic functions of four patients who underwent kidney transplantation because of kidney failure. We would like to first thank the authors that we do also inspect the improvement of cardiac function and recovery of the ventricular diameters in these patient groups after transplantation as our institution is also a major transplantation center in the country. The authors discussed their findings and they have stated that the improvement might be related to multiple parameters including the correction of volume and pressure overload, the restoration of normal hemoglobin levels, the clearance of uremic toxins, and being able to take heart failure medications. Even though major studies which have been held about this subject by Wali et al2 and Hawwa et al3 found no significant association between urea reduction ratio and body mass index in these patient groups, they have also stated that the change of ejection might be related to volume overload and uremic toxins, similar to your comments. However, there is no information about the hemoglobin levels, urea levels, and weight or body mass index of the patients before and after the transplantation in your cases. We believe that providing this information in your patient group would benefit the discussion and assessment of your findings.