Background – Pulmonary hypertension (PH) is common among patients with end stage renal disease (ESRD) who depend on dialysis before transplant, and PH is associated with higher mortality rates among ESRD patients. It is unknown the impact of PH on outcomes following kidney transplantation.

Methods – We conducted a retrospective study with data from 638 adult ESRD patients who were medically evaluated and then received a kidney transplant at a major transplant center in the Southeastern US between 2006-2010, with follow-up through 2011. Multivariable Cox models were used to assess whether PH, defined as having pulmonary arterial systolic pressure (PASP ≥ 35 mmHg), was a predictor for overall graft failure (death or graft failure event).

Results – The cohort of patients was comprised of 357 male (56.0%) and 284 white (44.5%) patients, with a mean age of 53.2 years. Out of the 638 transplant recipients, 209 patients (32.8%) had elevated PASP on preoperative echocardiography exam (mean 43.4 ± 9.7 mmHg), with 62 deaths (9.7%) and 55 graft failures (8.6%). Patients with PH prior to transplant had a lower graft survival rate at 5 years vs. patients without pulmonary hypertension (54.6% vs. 76.0%, p<0.05) and were nearly twice as likely to experience overall graft failure (crude HR 1.80, CI: 1.55, 2.08) during the study period [figure] In multivariable analyses, the association was attenuated but PH was still associated with a higher rate of graft failure (adjusted HR 1.30, CI: 1.11, 1.51).

Conclusions – The prevalence of pre-operative PH among kidney transplant recipients is high, and is associated with higher rates of graft failure. Noninvasive screening for PH prior to transplant could be useful to identify patients at higher risk for poor transplant outcomes.

Figure 1. Time to Overall Graft Failure among Patients by Pulmonary Hypertension Status

Table 1. Survival Table among Patients by Pulmonary Hypertension Status

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