Pulmonary hypertension common in kidney transplant recipients

Patients with pulmonary hypertension who underwent kidney transplantation had similar posttransplant outcomes at 5 years compared with those without pretransplant pulmonary hypertension, researchers reported in Pulmonary Circulation.

“Pulmonary hypertension more than doubles the risk of all-cause and cardiovascular-specific mortality in those on dialysis, and it increases the risk of adverse perioperative outcomes including death in noncardiac surgeries irrespective of kidney function. This risk profile may suggest that patients with pulmonary hypertension are poor kidney transplantation candidates,” Fadi Rabih, MD, faculty member in the division of pulmonary, allergy, critical care and sleep medicine at Emory University School of Medicine, and colleagues wrote. “However, limited reports suggest that restoring normal volume status results in improvements in both pulmonary hypertension and symptoms likely through correcting chronic volume overload.”

Researchers identified 350 patients (mean age, 51 years; 40% women) who underwent single-organ kidney transplantation at Emory Transplant Center from 2010 to 2011. Pulmonary hypertension presence was determined using pretransplantation echocardiography data obtained from electronic medical records and institutional transplant program data sources. At 5 years after transplantation, researchers evaluated patient outcomes.

One-third of patients had pulmonary hypertension.

Risk for mortality (13% vs. 8.7%; P =. 02), graft dysfunction (49% vs. 29%; P < .001) and graft failure (14% vs. 12%; P = .07) at 5 years posttransplantation was higher among patients with pulmonary hypertension compared with patients without pulmonary hypertension.

Pretransplant pulmonary hypertension was associated with a 43% greater risk for all outcomes after adjusting for age at transplant, male sex, history of hypertension, diabetes, autoimmune diseases or lung diseases, pulmonary hypertension presence, systolic or diastolic left ventricular dysfunction, pretransplant dialysis duration and prior kidney transplant (RR = 1.43; 95% CI, 1.189-1.724; P < .001).

Pretransplant pulmonary hypertension was not associated with a difference in posttransplant survival at 5 years.

“Patients with pulmonary hypertension should not be disregarded from consideration of kidney transplantation as an available treatment option for advanced chronic kidney disease and end-stage renal disease,” the researchers wrote. “The known benefits of improved quality and quantity of life afforded by kidney transplantation likely outweigh the marginal increased risk of graft dysfunction at 5 years demonstrated in our study population.”