Background Pulmonary hypertension has been associated with early allograft dysfunction and increased mortality following renal transplantation however this relationship has not been extensively studied. Methods We performed a retrospective cohort study of adult patients who underwent their first renal transplantation from 2003–2009 and had pre-transplantation echocardiograms. Pulmonary hypertension was defined as a right ventricular systolic pressure ≥ 40 mmHg in the absence of left-sided valvular disease and/or left ventricular ejection fraction ≤ 50%. The relationship between pulmonary hypertension and death-censored allograft failure (hemodialysis dependence or re-transplantation) and serum creatinine was assessed using Cox hazard regression and generalized mixed models. Eighty-two of 205 (40%) patients met inclusion criteria. Results The presence of pulmonary hypertension was associated with a 3.00 fold increase in the risk of death-censored allograft failure (95% confidence interval 1.20 – 7.32, p=0.02). Failure rates were 19% at 24 months and 51% at 96 months for those with pulmonary hypertension versus 7% at 24 months and 20% at 86 months for those without pulmonary hypertension (p=0.01). Among those without graft failure, there was an increase in creatinine levels after transplant (p=0.01). Effect estimates were unchanged by adjustment for multiple covariates and when pulmonary hypertension was defined as a right ventricular systolic pressure ≥ 36 mmHg. Conclusions Pulmonary hypertension prior to renal transplantation carries a 3.00-fold increased risk of death-censored allograft failure. The relationship between the pulmonary circulation and renal allograft failure warrants further study.

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