Pulmonary Hypertension Is Closely Related to Arterial Stiffness in Renal Transplant Patients

Bal, Zeynep; Sezer, Sıren; Uyar, Mehtap Erkmen; Bal, Uğur Abbas; Kulah, Eyup; Guliyev, O.; Tutal, Emre; Haberal, Mehmet

doi:10.1016/j.transproceed.2014.10.070

Cited by 7 publications

(7 citation statements)

References 13 publications

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“…These studies generally report no significant differences in demographic factors between recipients with and without P-HTN, possibly due to small sample sizes. 23,24 To our knowledge, ours is one of the largest studies to assess clinical correlates of P-HTN after KTx, including newly diagnosed P-HTN. The demographic factors correlated with posttransplant P-HTN were similar to those reported for pretransplant P-HTN in other studies, including older age, 16,24 obesity, 24,28 and longer dialysis duration.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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

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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…In patients undergoing pretransplant evaluation, PH has been detected in 17% . Several mechanisms have been proposed for the high prevalence of PH in end‐stage renal disease patients including decreased endothelial and vascular smooth muscle function, shear stress from a chronic high cardiac output state due to arteriovenous fistula for dialysis access, left‐sided cardiac dysfunction due to chronic volume overload and hypertension, and potential repeated microair bubble pulmonary embolism . Additionally, impaired diastolic dysfunction as reflected by left ventricular hypertrophy has also been proposed to play a role in the development of PH .…”

Section: Discussionmentioning

confidence: 99%

Influence of mildly and moderately elevated pulmonary artery systolic pressure on post‐renal transplantation survival and graft function

et al. 2018

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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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“…Elevated pulmonary artery systolic pressure (PASP), defining pulmonary hypertension (PH), is rare in the general population but is common among patients with end-stage renal disease (ESRD), and has been shown to be associated with higher mortality rates [1–3]. Despite the significant effect of elevated pulmonary pressures on ESRD patient survival, limited attention has been given to the progression/regression of elevated PASP after kidney transplant [4–10]. Screening for pulmonary pressure is being performed using echocardiogram (ECHO) on ESRD patients undergoing kidney transplant evaluation.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Artery Systolic Pressure Measured Intraoperatively by Right Heart Catheterization Is a Predictor of Kidney Transplant Recipient Survival

et al. 2018

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BackgroundThe effect of pulmonary artery systolic pressure (PASP) measured by Swan-Ganz right heart catheter (SG-RHC) on kidney transplant recipient survival has not been previously studied. The objective of this study was to assess the relationships between PASP measured via SG-RHC, done intraoperatively at the time of initiating anesthesia at the beginning of kidney transplant surgery, and patient survival. Multiple comorbidities, time on dialysis before the transplantation, and graft function were also analyzed in our study.Material/MethodsThis was a retrospective cohort study using data from all consecutive patients undergoing kidney transplant between January 1, 2005 and December 31, 2009 at Tampa General Hospital. Kidney transplant recipients were divided into 2 groups: Group 1 with PASP <35 mmHg and group 2 with PASP ≥35 mmHg. Patients and graft survival data, time on dialysis before transplant, and comorbidities were compared between the 2 groups.ResultsOnly 363 patients were found to have a documented PASP measurement at the time of anesthesia induction for the transplant surgery, and were included in the specific analysis of our study. Patients with PASP ≥35 mmHg showed a significant decrease in survival in comparison to patients having PASP values <35 mmHg (HR 1.88; 95% CI 1.012 to 3.47, P=0.04). There was a significant positive correlation between time on dialysis and PASP (rho 0.20; 95% CI 0.09 to 0.30, p<0.001), as well as a significant difference in median time on dialysis between PASP <35 vs. PASP ≥35 (22 vs. 29 months, p=0.004). There were no significant differences in graft failure between the 2 PASP groups (HR 0.34; 95% CI 0.12 to 1.01, P=0.05).ConclusionsPatients with PASP ≥35 mmHg, measured intraoperatively by SG-RHC, showed significantly shorter survival in comparison to patients having PASP values <35 mmHg. This result suggests the need for a randomized controlled trial to address the importance of post-transplant pulmonary hypertension management in patient survival.

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Pulmonary Hypertension Is Closely Related to Arterial Stiffness in Renal Transplant Patients

Cited by 7 publications

References 13 publications

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

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

Influence of mildly and moderately elevated pulmonary artery systolic pressure on post‐renal transplantation survival and graft function

Pulmonary Artery Systolic Pressure Measured Intraoperatively by Right Heart Catheterization Is a Predictor of Kidney Transplant Recipient Survival

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