The Association of Pretransplant Pulmonary Hypertension With Patient and Graft Survival After Kidney Transplantation: A Retrospective Cohort Study

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

“…All included studies were observational and had a retrospective design [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Most studies evaluated echocardiographic parameters as indirect markers of PH [ 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], while only one study included right heart catheterization in PH diagnostic algorithm [ 19 ]. PH was defined by using pulmonary artery systolic pressure (PASP) estimated by TTE in six studies [ 20 , 22 , 23 , 24 , 25 , 27 ].…”

“…Most studies evaluated echocardiographic parameters as indirect markers of PH [ 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], while only one study included right heart catheterization in PH diagnostic algorithm [ 19 ]. PH was defined by using pulmonary artery systolic pressure (PASP) estimated by TTE in six studies [ 20 , 22 , 23 , 24 , 25 , 27 ]. Right ventricular systolic pressure (RVSP), maximum tricuspid regurgitation jet velocity (TRJV), and right ventricular dilation and function were other TTE parameters used in clinical trials to estimate PH [ 18 , 21 , 26 , 28 , 29 ].…”

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

“…Prior reports of the impact of pretransplant PH on outcomes following kidney transplantation have been contradictory. The single largest report of carefully characterized single organ primary kidney transplant recipients 5 found that echo‐defined PH (PA systolic pressure of ≥35 mmHg) was present in 15.6% of patients. That study by Obi et al 5 was the single largest report of demographics and outcomes of echocardiographically defined PH in a kidney transplant population and reported that, by multivariable analyses, the presence of PH while associated with other risk factors for worse outcome (notably dialysis vintage, race, and age) was not itself a risk factor for a poorer outcomes (mortality, death censored graft loss, or the composite of death or graft loss) 5 .…”

“…The single largest report of carefully characterized single organ primary kidney transplant recipients 5 found that echo‐defined PH (PA systolic pressure of ≥35 mmHg) was present in 15.6% of patients. That study by Obi et al 5 was the single largest report of demographics and outcomes of echocardiographically defined PH in a kidney transplant population and reported that, by multivariable analyses, the presence of PH while associated with other risk factors for worse outcome (notably dialysis vintage, race, and age) was not itself a risk factor for a poorer outcomes (mortality, death censored graft loss, or the composite of death or graft loss) 5 . This lack of adverse impact of pretransplant PH on outcomes following kidney transplantation contrasts sharply with the increased mortality seen in patients with liver disease‐associated PAH, 12 and in heart transplant candidates and recipients with PH 13 .…”

“…Increasingly physicians with expertize in PH are being asked to evaluate and or treat such patients before kidney transplantation. In 2020, in the largest series reported to date, risk factors associated with the echocardiographic finding of PH (e.g, race, left ventricular [LV] systolic function, and age at presentation), but not PH itself, were associated by multivariable analysis with observed patient or graft loss 5 . The study also indicated that in most cases the PH was associated with features of LV diastolic dysfunction.…”