The echocardiographic course of pretransplant pulmonary hypertension following kidney transplantation and associated outcomes

Abstract The post 3 kidney transplant course of pretransplant echocardiographically‐defined pulmonary hypertension (PH) was reviewed in 115 patients. Of these 61 patients (the largest cohort reported to date), underwent 160 “for indication” echocardiograms posttransplant (mean echocardiograms per patient: 2.6 ± 2.3). Patients undergoing posttransplant echocardiograms demonstrated greater risks for worse outcomes than those without posttransplant echocardiograms; however, there was no difference in mortality, death‐censored graft failure or the composite of death or graft failure between these two groups. Of patients tested, 36 (59%) showed resolution of PH at a median of 37.5 months. Six patients (16.7%) in whom PH resolved (at a median of 29 months), experienced recurrence of PH after an interval of 48 months. No pretransplant demographic or echocardiographic characteristics distinguished those in whom PH persisted versus resolved. Though there was no difference in the risk for mortality or death‐censored graft loss between the two groups at 3 and 5 years, there was a higher risk for the composite of mortality or graft loss at three but not at five years in the group with persistent PH. In conclusion, echocardiographically defined PH resolved in 59% of patients following kidney transplantation; but irrespective of resolution there was no clear association with worse outcome.

[1]  T. Villines,et al.  Incidence, Clinical Correlates, and Outcomes of Pulmonary Hypertension After Kidney Transplantation: Analysis of Linked US Registry and Medicare Billing Claims , 2021, Transplantation.

[2]  A. Israni,et al.  OPTN/SRTR 2019 Annual Data Report: Kidney , 2021, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[3]  W. Suki,et al.  The Association of Pretransplant Pulmonary Hypertension With Patient and Graft Survival After Kidney Transplantation: A Retrospective Cohort Study. , 2020, Transplantation proceedings.

[4]  Joseph A. Sivak,et al.  Five-year Outcomes of Pulmonary Hypertension With and Without Elevated Left Atrial Pressure in Patients Evaluated for Kidney Transplantation , 2019, Transplantation.

[5]  R. Condliffe,et al.  Identifying early pulmonary arterial hypertension in patients with systemic sclerosis , 2018, European Respiratory Journal.

[6]  M. Gladwin,et al.  Redefining pulmonary hypertension. , 2017, The Lancet. Respiratory medicine.

[7]  A. Wysocka,et al.  The reverse remodeling of the aorta in patients after renal transplantation - the value of aortic stiffness index: prospective echocardiographic study , 2017, BMC Nephrology.

[8]  W. Tang,et al.  Reverse Remodeling and Prognosis Following Kidney Transplantation in Contemporary Patients With Cardiac Dysfunction. , 2015, Journal of the American College of Cardiology.

[9]  A. Hemnes.  Pulmonary arterial hypertension treatment guidelines: new answers and even more questions. , 2014, Chest.

[10]  Mary G. George,et al.  Pulmonary Hypertension Surveillance , 2014, Chest.

[11]  G. Maurer,et al.  Left atrial diameter and survival among renal allograft recipients. , 2013, Clinical journal of the American Society of Nephrology : CJASN.

[12]  M. Webster,et al.  Do Echocardiographic Parameters Predict Mortality in Patients With End-Stage Renal Disease? , 2013, Transplantation.

[13]  K. Chin,et al.  International Classification of Diseases coding changes lead to profound declines in reported idiopathic pulmonary arterial hypertension mortality and hospitalizations: implications for database studies. , 2011, Chest.

[14]  A. Frost,et al.  A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance , 2010, International journal of general medicine.

[15]  Jeremiah R. Brown,et al.  Non-invasive detection of pulmonary hypertension prior to renal transplantation is a predictor of increased risk for early graft dysfunction. , 2010, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[16]  T. Momose,et al.  Improvement of cardiac function after kidney transplantation with dilated cardiomyopathy and long dialysis vintage , 2009, NDT plus.

[17]  M. Yigla,et al.  Pulmonary hypertension is an independent predictor of mortality in hemodialysis patients. , 2009, Kidney international.

[18]  M. Stegall,et al.  Pulmonary Hypertension Is Associated With Reduced Patient Survival After Kidney Transplantation , 2008, Transplantation.

[19]  S. Abdelwhab,et al.  Pulmonary Hypertension in Chronic Renal Failure Patients , 2008, American Journal of Nephrology.

[20]  M. Fisher,et al.  Effect of kidney transplantation on left ventricular systolic dysfunction and congestive heart failure in patients with end-stage renal disease. , 2005, Journal of the American College of Cardiology.

[21]  M. Yigla,et al.  Pulmonary hypertension in patients with end-stage renal disease. , 2003, Chest.

[22]  J. Schroeder,et al.  The influence of preoperative patient characteristics on early and late survival following cardiac transplantation. , 1991, Circulation.

[23]  J. Heimbach,et al.  Frequency and Outcomes of Patients With Increased Mean Pulmonary Artery Pressure at the Time of Liver Transplantation , 2017, Transplantation.

[24]  T. Villines,et al.  Evaluation and Management of Pulmonary Hypertension in Kidney Transplant Candidates and Recipients: Concepts and Controversies , 2017, Transplantation.

[25]  S. Solomon,et al.  GUIDELINES AND STANDARDS , 2010 .