Prevalence and Outcomes of Pulmonary Embolism in Patients with Kidney Transplant

Ankit Sakhuja MD, Jesse D Schold PhD, Diana Deitzer DO, Brian Stephany MD

Introduction: This study was designed to examine prevalence and outcomes of pulmonary embolism (PE) among kidney transplant recipients in comparison to those on chronic dialysis and general population (GP).

Methods: Using Nationwide Inpatient Sample Database from 2007-2009, patients with primary discharge diagnosis of PE were identified. Patients were divided into three subgroups based on renal function – kidney transplant, chronic dialysis and GP. Patients who underwent kidney transplant that same admission were excluded. Prevalence of PE based on renal function was estimated using data from USRDS and US Census. Primary outcomes included all-cause inpatient mortality and discharge disposition. Logistic regression analysis was used to examine predictors of inpatient mortality after adjusting for renal function, demographics, Charlson's comorbidity index, primary payer, hospital characteristics.

Results: The prevalence of PE in those with chronic dialysis, kidney transplant and GP was 478, 227 and 70 per 100,000 population respectively. Among patients with PE, kidney transplant patients were younger than those on chronic dialysis or GP (means 52.2yr, 59.2yr, 62.5yr; p<0.001), had higher proportion of Caucasians than chronic dialysis patients and were more often admitted to teaching hospitals. The unadjusted mortality for those with PE was highest in those with chronic dialysis and lowest in those with transplant (6.7% vs 1.7% vs 3.3% GP; p<0.001). Most transplant recipients were discharged home in comparison to those with chronic dialysis or GP (70.2% vs 57.8% vs 64.5%; p<0.001) & less often are transferred to SNFs (9.1% vs 21.3% vs 15.4%; p<0.001). On multivariate regression, chronic dialysis status but not kidney transplant status was associated with higher mortality in those with PE (OR 1.69; 95% CI: 1.32, 2.17 for chronic dialysis and OR 0.65; 95% CI: 0.23, 1.83 for kidney transplant) in addition to older age, African American or asian race, having Medicaid or self pay primary payer status and admission to a teaching hospital.

Conclusions: Prevalence of PE in patients with kidney transplant is lower than those with chronic dialysis but higher than the general population. Transplant patients with PE however have excellent outcomes.

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