What is the clinical evidence from this study?

Study design: Observational. Population: Adult kidney transplant recipients with or without pre-transplant pulmonary hypertension (n=468). Intervention: Pre-transplant pulmonary hypertension vs. No pre-transplant pulmonary hypertension. Primary outcome: Major adverse cardiovascular events (MACE) defined as cardiovascular death, nonfatal myocardial infarction, stroke, or hospitalization for heart failure after kidney transplantation (HR 2.15, 95% CI 1.25-3.70, p=0.01).

What question did this study set out to answer?

To examine the link between pre-transplant pulmonary hypertension and long-term cardiovascular events in kidney transplant recipients.

March 1, 2026Open Access

Association of pre-transplant pulmonary hypertension and post-transplant major adverse cardiovascular events in kidney transplant recipients: a retrospective study

Resultado clave

Pre-transplant pulmonary hypertension was independently associated with a 2.15-fold increased risk of major adverse cardiovascular events after kidney transplantation (22.0% vs 11.0% at 5 years, HR 2.15, 95% CI 1.25-3.70, p=0.01).

Puntos clave

To examine the link between pre-transplant pulmonary hypertension and long-term cardiovascular events in kidney transplant recipients.
Conducted a retrospective cohort study of 468 kidney transplant recipients from January 2015 to January 2024.
Patients were categorized based on presence of pre-transplant pulmonary hypertension based on specific pressure criteria.
Used Kaplan-Meier curves and Cox proportional hazards models for analysis.
Of the 468 recipients, 86 (18.4%) had pre-transplant pulmonary hypertension.
Over a mean follow-up of 54.7 months, 89 patients (19.0%) experienced major adverse cardiovascular events (MACE).
MACE incidence at one year was significantly higher in the pulmonary hypertension group (8.1% vs 2.9%).
After adjustment, pre-transplant pulmonary hypertension was associated with a hazard ratio of 2.15 for MACE.

Diseño del estudio

Tipo

Observational (n=468)

Multicéntrico

PICO estructurado

Does pre-transplant pulmonary hypertension increase the risk of major adverse cardiovascular events in adult kidney transplant recipients?

Población

468 adult kidney transplant recipients from a single academic medical center in the United States, mean age 53.8, 56.6% male. Excluded: patients without follow-up within the healthcare system and those without an available pre-transplant transthoracic echocardiogram or right heart catheterization with adequate assessment of pulmonary artery pressure.

Intervención

Pre-transplant pulmonary hypertension (PH), defined as estimated pulmonary artery systolic pressure > 35 mmHg on echocardiography or mean pulmonary artery pressure > 20 mmHg via right heart catheterization.

Comparador

Absence of pre-transplant pulmonary hypertension (NoPH group).

Resultado

Composite of major adverse cardiovascular events (MACE) after kidney transplantation, defined as cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure.composite

Pre-transplant pulmonary hypertension is independently associated with a more than two-fold increased risk of major adverse cardiovascular events following kidney transplantation, highlighting the need for enhanced cardiovascular surveillance in this population.

Resultado numérico

Estimación del efecto: HR 2.15 (95% CI 1.25-3.70)

Tasa de eventos absoluta: 22% vs 11%

valor p: p=0.01

Limitaciones

Retrospective single-center design limits generalizability.
Predominant reliance on echocardiography rather than right heart catheterization for PH diagnosis.
Potential residual confounding from unmeasured factors such as dialysis duration and anemia.
Mild pulmonary hypertension predominated due to transplant eligibility criteria, limiting analysis by PH severity.
Association lost strict significance in competing risk model accounting for non-cardiac death, indicating partial influence of competing mortality.

Resumen

Pulmonary hypertension (PH) frequently complicates end-stage kidney disease, contributing significantly to cardiovascular morbidity and mortality. Some of the pathophysiologic effects of PH may persist even after kidney transplantation (KT). We investigated the association between pre-transplant PH and long-term major adverse cardiovascular events (MACE) after KT. This retrospective cohort study included 468 adult KT recipients from an academic medical center between January 2015 and January 2024. We excluded patients who did not follow up at our institution and those with no adequate pre-transplant assessment of pulmonary artery (PA) pressures. Patients were stratified based on the presence of pre-transplant PH, defined as PA systolic pressure > 35 mmHg on echocardiography or mean PA pressure > 20 mmHg via right heart catheterization. The primary outcome was the occurrence of MACE after KT, defined as cardiovascular death, nonfatal myocardial infarction, stroke, or hospitalization for heart failure. Kaplan-Meier cumulative incidence curves and Multivariable Cox proportional hazards models were used. Of the 468 recipients who qualified for the study, 86 (18.4%) had pre-transplant PH. Over a mean follow-up of 54.7 ± 28.4 months, 89 patients (19.0%) experienced MACE. The incidence of MACE was significantly higher in the PH group at one- (8.1 vs 2.9%, p = 0.03) and five-year (22.0 vs 11.0%, p = 0.01). After adjusting for age, sex, and relevant confounders, PH remained independently associated with MACE (HR 2.15; 95% CI 1.25–3.70; p = 0.01). In this retrospective single-center study, pre-transplant PH was independently associated with an increased risk for MACE following KT. These findings highlight the importance of identifying PH in KT candidates. Enhanced cardiovascular risk surveillance may be warranted in this population. Not applicable as this is a retrospective cohort study.

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