Pulmonary hypertension in renal transplant candidates: A systematic review and meta-analysis of the available evidence and a proposed algorithm for pre-transplant management

Moza, Ankush; Khan, Abdur Raheem; Parashar, Rohini; Khan, Sobia; Khouri, Samer; Ortíz, Jorge; Malhotra, Deepak; Rees, Michael; Moukarbel, George V.

doi:10.15761/tit.1000236

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…Regarding the prognostic value of PH in KT candidates, one meta-analysis published in 2017 reported that patients with PH had a higher mortality risk than those without PH (OR 3.15, 95% CI, 1.42–6.97, p = 0.005). However, this paper included only three studies with a small sample analyzed ( n = 502) [ 14 ]. Moreover, one included study did not specify if all KT candidates underwent KT during follow-up [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Arterial Hypertension and Adverse Outcomes after Kidney Transplantation: A Systematic Review and Meta-Analysis

Brinza

Covic

Stefan

et al. 2022

JCM

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Pulmonary arterial hypertension (PH) has a high prevalence in chronic kidney disease (CKD) patients, especially those undergoing kidney transplantation (KT). We aimed to systematically review and calculate the pooled effect size of the literature evaluating the association between pre-existing PH documented by transthoracic echocardiography (TTE) or invasively and adverse outcomes following KT. The primary composite outcome extracted from the included studies was represented by the mortality from any cause following KT and delayed graft function (DGF), graft dysfunction, or graft failure. The secondary outcomes were represented by individual components of the primary composite outcome. Twelve studies meeting the inclusion criteria were selected. The main finding is that pre-existing PH was associated with increased mortality and a higher rate of DGF, kidney graft dysfunction, or failure in KT recipients. The effect remained significant for all outcomes irrespective of PH evaluation, invasively or using TTE. Consequently, patients with PH defined only by TTE were at higher risk of death, DGF, or graft failure. Our findings support the routine assessment of PH in patients on the KT waitlist. PH might represent an extensively available and valuable tool for risk stratification in KT patients. These data should be confirmed in large prospective clinical trials.

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Section: Introductionmentioning

confidence: 99%

Pulmonary Arterial Hypertension and Adverse Outcomes after Kidney Transplantation: A Systematic Review and Meta-Analysis

Brinza

Covic

Stefan

et al. 2022

JCM

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“…It is associated with worse outcomes, including both worse survival and increased hospitalizations. 4,[8][9][10][11] Among KT recipients, PH is independently associated with more than threefold increased risk of posttransplant death 12 and increased risk of graft dysfunction. 13 Moreover, the presence of CKD is associated with worse survival and increased hospitalizations among pulmonary arterial hypertension (PAH) patients.…”

Section: Introductionmentioning

confidence: 99%

“…Importantly, PH in CKD has significant prognostic implications. It is associated with worse outcomes, including both worse survival and increased hospitalizations 4,8–11 . Among KT recipients, PH is independently associated with more than threefold increased risk of posttransplant death 12 and increased risk of graft dysfunction 13 .…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic response to inhaled nitric oxide in patients with pulmonary hypertension and chronic kidney disease: A retrospective cohort study

del Valle,

Krowka,

Schinstock

et al. 2024

Pulm. circ.

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Pulmonary hypertension (PH) associated with chronic kidney disease (CKD) (PH‐CKD) affects approximately 20%–40% of CKD patients and is associated with increased morbidity and mortality. PH and CKD are both pathophysiologically associated with nitric oxide (NO) deficiency. The NO pathway, an important therapeutic domain in pulmonary arterial hypertension (PAH), is an intriguing but unexplored target in PH‐CKD. We sought to improve understanding of the clinical significance of the NO pathway in patients with PH‐CKD by assessing the hemodynamic response to inhaled NO (iNO) during right heart catheterization (RHC). In this retrospective cohort study, patients with diagnosis codes of PH and stage IV/V CKD or end‐stage renal disease and estimated glomerular filtration rate < 60 mL/min/body surface area who underwent RHC and hemodynamic drug study between July 2011 and June 2021 were eligible. Patients with mean pulmonary artery pressure (mPAP) > 20 mmHg and pulmonary vascular resistance (PVR) > 3 Wood units were included. The final cohort included 37 patients (45.9% female, mean age 72.5 ± 9.7 years). A total of 56.7% of the cohort (21/37) had precapillary PH, while 43.2% (16/37) had combined precapillary postcapillary PH (Cpc‐PH). Median survival was 3.1 years after RHC. iNO was associated with a significant decrease in both mPAP and PVR. Hemodynamic changes in mPAP and PVR were similar in precapillary and Cpc‐PH groups. Among a small subset (n = 14) who were subsequently treated with PAH‐targeted therapy, treatment response was mixed and did not reveal significant benefit. Further studies are warranted to better define the potential role of PAH therapy in PH‐CKD.

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Brain-type natriuretic peptide levels and invasive hemodynamic parameters in dialysis dependent patients

Ariss

Alhazmi

Nazir

et al. 2023

The American Journal of the Medical Sciences

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Pulmonary hypertension in renal transplant candidates: A systematic review and meta-analysis of the available evidence and a proposed algorithm for pre-transplant management

Cited by 3 publications

References 22 publications

Pulmonary Arterial Hypertension and Adverse Outcomes after Kidney Transplantation: A Systematic Review and Meta-Analysis

Pulmonary Arterial Hypertension and Adverse Outcomes after Kidney Transplantation: A Systematic Review and Meta-Analysis

Hemodynamic response to inhaled nitric oxide in patients with pulmonary hypertension and chronic kidney disease: A retrospective cohort study

Brain-type natriuretic peptide levels and invasive hemodynamic parameters in dialysis dependent patients

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