Clinical impact of pre-kidney transplant pulmonary hypertension on post-transplant outcomes


Outcomes of kidney transplant (KT) patients with pre-transplant pulmonary hypertension (PH) are poorly understood. PH patients are often considered high risk and excluded from KT. We investigated the association of pre-transplant PH with KT recipient’s outcomes. A single-center, retrospective study that reviewed all patients transplanted from 2010 to 2016, who had a transthoracic echocardiogram (TTE) before KT and at least one TTE post-KT. The TTE closest to the KT was used for analyses. PH is defined as pulmonary artery systolic pressure (PASP) ≥ 40 mm Hg. Of 204 patients, 61 had PASP ≥ 40 mm Hg (with PH) and 143 had PASP < 40 mm Hg (without PH) prior to KT. No statistically significant differences existed between the two groups in baseline demographics, renal failure etiologies, dialysis access type, and cardiovascular risk factors. The mean difference in pre-KT PASP was 18.1 ± 7 mm Hg (P < 0.001). Patients with PH had a statistically significant decrease in PASP post-KT compared to the patients without PH with a mean change of -7.03 ± 12.28 mm Hg vs. + 3.96 ± 11.98 mm Hg (p < 0.001), respectively. Moderate mitral and moderate-severe tricuspid regurgitation were the only factors found to be independently associated with PH (p = 0.001) on multivariable analysis. No statistically significant difference was notable in patient survival, graft function, and creatinine post-KT in both groups. PH pre-KT particularly mild-moderate PH did not adversely affect intermediate (90-day) and long-term allograft and patient survival. Patients with mild-moderate PH should not be excluded from KT.

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KA, VK, BS, DT had full access to all of the data in the study and assume the responsibility for the integrity of the data and the accuracy of the analysis. BS, DT contributed substantially to the study design, data collection, data interpretation, and the writing and editing of this manuscript. KA, VK, MS, AP contributed to the study design and data collection. MVH contributed to statistical analysis. Stephanie Stebens contributed to the editing and formatting of this manuscript.

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Correspondence to Karthikeyan Ananthasubramaniam.

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The authors declare that they have no conflict of interest.

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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Henry Ford Health System approved this study.

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Prior presentation: The work was presented as a poster at the Michigan Chapter of the American College of Cardiology 30th Annual Conference, Detroit, MI, October 26-27, 2018.

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Sadat, B., Tirunagari, D., Karthikeyan, V. et al. Clinical impact of pre-kidney transplant pulmonary hypertension on post-transplant outcomes. Int J Cardiovasc Imaging (2021).

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  • Pulmonary hypertension
  • End-stage kidney disease
  • Kidney transplant
  • Survival