Renal transplant improves pulmonary hypertension in patients with end stage renal disease

Abstract

BackgroundPulmonary hypertension (PH) is present in a significant proportion of patients with end stage renal disease (ESRD) and is of prognostic importance. Data on the effect of renal transplant on PH is very limited. In this study, the aim was to examine the effect of renal transplant on systolic pulmonary artery pressure (SPAP) determined by Doppler echocardiography.MethodsAnalysis was performed on the records of 500 consecutive patients who underwent renal transplant at our center between the years 1999 to 2008. The prevalence of PH in the preoperative assessment period was established. Patients were diagnosed as having PH when measured SPAP values were > 35 mm Hg.ResultsPulmonary hypertension was detected in 85 of the 500 (17%) patients under pre-transplant evaluation. At post-transplant follow up Doppler echocardiographic examination was performed on 50 of the 85 patients. After exclusion of 8 cases (1 due to massive pulmonary thromboemboli; 7 due to graft failure requiring dialysis therapy) analyses were performed on 42 patients who had undergone both pre- and post-transplant echocardiographic examination. Mean SPAP at pre-transplant evaluation was 45.9 ± 8.8 mm Hg and in 6 (14.3%) cases SPAP was above 50 mm Hg.Compared to pre-transplant values, a significant decrease was observed in mean SPAP values in an average of 53 months of postoperative follow up (41.8 ± 7.4 mm Hg vs. 45.9 ± 8.8 mm Hg, p < 0.0001).ConclusionThese findings indicate that patients with ESRD accompanied by PH may benefit from renal transplant. Further research is required for more concrete conclusions to be drawn on this subject.

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

“…The overall prevalence of elevated pulmonary pressure among patients undergoing renal transplantation in our analysis was 26.6%. This rate is similar to previous studies examining the prevalence of PH in end‐stage renal disease patients . Elevated pretransplant PASP did not increase 4‐year mortality or graft loss, but was associated with significantly decreased graft function manifesting with lower eGFR at 1 year and 2 years post‐transplantation.…”

“…A previous study reported that in patients undergoing pretransplant evaluation with transthoracic echocardiography (TTE), PH has been detected in 17% of patients with a mean pulmonary arterial systolic pressure (PASP) of 45.9 ± 8.8 mm Hg . Despite the high prevalence of PH in end‐stage renal disease patients considered for kidney transplantation, data on post‐transplant outcomes in patients with pretransplant mild‐to‐moderate PH are very limited.…”

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

“…At the same time there are numerous observations of improvement in PHT along with other echocardiographic parameters after renal transplantation [1,12,25,26]. This has led many to propose that PHT can be used as an indication for expeditious renal transplantation [12,25,26].…”

“…A clear cutoff of severity of pulmonary artery pressures beyond which mortality risk increases is not well defined. It has been suggested that patients with mild to moderate PHT may be considered for expedited transplantation to prevent the PHT from worsening and potentially improve it [1,12,25,26] and severe PHT may be treated before transplantation to improve patient and graft outcomes.…”

Reversible pulmonary hypertension in post -renaltransp lantation patient with longst anding arteriovenous fistula

“…Распро страненность ЛГ после успешной трансплантации почки (ТП) существенно ниже: порядка 5-14% [5]. Опубликованы результаты ряда исследований, сви детельствующие о значительном регрессе клинико инструментальных признаков ЛГ после ТП [6][7][8].…”