BACKGROUND: Left ventricular hypertrophy, ventricular dilatation and poor systolic function prior to renal transplantation are associated with increased mortality. However, whether the improvement in these echocardiographic indices that is reported to follow renal transplantation improves patient survival has not been investigated. METHODS: We studied 67 patients who underwent renal transplantation in our unit between 1988 and 1990 and in whom echocardiography was performed immediately prior to transplant surgery and 4 months later. Pre- and post-transplantation echocardiographic parameters were compared between the 20 patients who have since died and surviving patients and a descriptive survival analysis was performed. RESULTS: Following transplantation there was no significant change in left ventricular mass index (LVMI) or end diastolic diameter (EDD). End systolic diameter (ESD) improved in 60% of patients (median 3.3 vs 3. 7 cm; P=0.031) as did fractional shortening in 67% (0.33 vs 0.29; P=0.001). However, improvement was not associated with survival benefits. We also found that prior to transplantation, fractional shortening, ESD and EDD were strongly associated with outcome; this was no longer the case following transplantation. In contrast, LVMI provided a stronger association with adverse outcome (albeit of limited statistical significance) following transplantation. CONCLUSIONS: In this Preliminary Report, we conclude that echocardiographic parameters are associated with adverse outcome in patients receiving renal replacement therapy (RRT). Different echocardiographic parameters are associated with adverse outcome before and after renal transplantation and improvement of pre-transplant abnormalities (e.g. poor LV systolic function) following transplantation does not necessarily confer survival benefits. Whether this is a genuine observation or a reflection of the interpretation of echocardiographic measurements in dialysis patients requires further investigation.