Key result
Elevated pretransplant PASP linked to ~8 mL/min lower eGFR at one year post-transplant.
Why the study?
Data on post-transplant renal allograft survival in recipients with pre-existing mild-to-moderate pulmonary hypertension are limited despite high PH prevalence in end-stage renal disease patients.
Does mildly and moderately elevated pretransplantation pulmonary artery systolic pressure reduce post-renal transplantation survival and graft function in renal transplant recipients?
Cohort (n=192)
No
Does mildly and moderately elevated pretransplantation pulmonary artery systolic pressure reduce post-renal transplantation survival and graft function in renal transplant recipients?
Absolute Event Rate: 52.26% vs 60.13%
p-value: p=0.019
Mild to moderately elevated pre-kidney transplant PASP is associated with decreased short-term renal graft function but does not affect 4-year mortality.
Mild-moderate pretransplant PH should not alter candidacy decisions; leaves open whether it impairs longer-term graft function.
BACKGROUND: Severe pulmonary hypertension (PH) has been associated with decreased post-kidney transplant survival and increased rate of long-term cardiovascular complications. Despite a high prevalence of PH in patients with end-stage renal disease, data on post-transplant renal allograft survival in recipients with pre-existing mild-to-moderate PH are limited. METHODS: The single-center retrospective study cohort consisted of 192 consecutive (2008-2015) renal transplant recipients with documented pretransplantation transthoracic echocardiogram (TTE) pulmonary artery systolic pressure (PASP). Mean age was 50.9 ± 12.4 years, 36.5% were females, and 81.25% were Caucasians. RESULTS: Elevated PASP ≥ 37 mm Hg was present in 51 patients. Elevated PASP was more common in patients with decreased <50% left ventricular ejection fraction (13.73% vs 3.55%, P = 0.010); otherwise, there were no significant differences in baseline demographic (age, ethnicity, gender, and donor status) and clinical parameters between patients with normal and elevated PASP. Four-year mortality (5.7%) was not significantly affected by elevated PASP. However, elevated PASP was associated with significantly decreased estimated glomerular filtration rate (eGFR) at 1 year (52.26 vs 60.13 mL/min, P = 0.019) and 2 years (51.04 vs 60.28 mL/min, P = 0.006) post-transplant. CONCLUSION: Mild and moderately elevated pre-kidney transplant PASP does not affect 4-year post-transplant mortality or graft loss. However, elevated pretransplant PASP is significantly associated with decreased 1 year and 2 years post-transplant eGFR. Preoperative echocardiographic evaluation for PH may be useful in predicting the probability of short-term renal graft and long-term graft dysfunction in these patients.
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Wang et al. (2018) conducted a cohort in End-stage renal disease (n=192). Elevated pulmonary artery systolic pressure (≥ 37 mm Hg) vs. Normal pulmonary artery systolic pressure was evaluated on Estimated glomerular filtration rate (eGFR) at 1 year post-transplant (p=0.019). Elevated pretransplant pulmonary artery systolic pressure (≥37 mm Hg) was associated with significantly decreased eGFR at 1 year (52.26 vs 60.13 mL/min, P=0.019) and 2 years post-transplant.
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