Incidence, Clinical Correlates, and Outcomes of Pulmonary Hypertension After Kidney Transplantation: Analysis of Linked US Registry and Medicare Billing Claims

Abstract

Background. The incidence, risks, and outcomes associated with pulmonary hypertension (P-HTN) in the kidney transplant (KTx) population are not well described. Methods. We linked US transplant registry data with Medicare claims (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) to investigate P-HTN diagnoses among Medicare-insured KTx recipients (N = 35 512) using billing claims. Cox regression was applied to identify independent correlates and outcomes of P-HTN (adjusted hazard ratio [aHR] 95%LCL aHR 95%UCL ) and to examine P-HTN diagnoses as time-dependent mortality predictors. Results. Overall, 8.2% of recipients had a diagnostic code for P-HTN within 2 y preceding transplant. By 3 y posttransplant, P-HTN was diagnosed in 10.3 10.6% 11.0 of the study cohort. After adjustment, posttransplant P-HTN was more likely in KTx recipients who were older (age ≥60 versus 18-30 y a HR, 1.91 2.40 3.01 ) or female (aHR, 1.15

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

“…PH resolved in the cohort reported herein in 36 (59%) patients, a proportion similar to the number inferred from the data in the manuscript by Lentine et al 16…”

“…PH resolved in the cohort reported herein in 36 (59%) patients, a proportion similar to the number inferred from the data in the manuscript by Lentine et al 16 (50%). Herein it is reported that PH resolution occurred at a median of 37.5 months posttransplant.…”

“…In six patients in whom PH had resolved, it recurred at a median of 48 months from the date of initial resolution. These data suggest that the risks associated with both the underlying etiologies of end‐stage renal disease, the metabolic derangements imposed by chronic kidney disease (CKD) and dialysis, or factors posttransplant (calcineurin inhibitors, hypertension, new‐onset diabetes) may account for the de novo PH reported by Lentine et al 16 and the recurrence of PH reported herein. The small numbers (6) of patients in our cohort with echocardiographically confirmed recurrent PH preclude meaningful evaluation of outcomes or possible associated risk factors.…”

“…That publication provided no echocardiographic post‐transplantation data. Similarly, data from a single US center registry 16 (University of North Carolina) reported 97 patients with PH out of a cohort of 778 patients screened for kidney transplant. While this group reported a higher mortality in patients with PH the review was largely an evaluation of pretransplant mortality on the kidney transplant wait list, as only 15 patients with pretransplant echocardiographically defined PH underwent kidney transplantation 15 and no posttransplantation echocardiographic data was reported.…”

“…A recent publication 16 , 17 using the International Classification of Diseases (ICD‐9/10) codes to identify pretransplant and posttransplant PH reported that ICD9/10 codes for PH were present in 8.2% of kidney transplant recipients at some point in the 2 years before transplantation. In addition, while posttransplant mortality was reported to be substantially higher in those with posttransplant PH, this finding is driven largely by those who develop PH (again by ICD‐9/10 code definition) following kidney transplantation.…”