Cardiology, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Nephrol Dial Transplant. 2010 Sep;25(9):3090-6. doi: 10.1093/ndt/gfq141. Epub 2010 Mar 17.
Early graft dysfunction is a significant complication after renal transplantation and is a marker of adverse outcomes. Although multiple predictors of graft dysfunction have been previously described, the reported prevalence of pulmonary hypertension (pulmonary HTN) in the dialysis population (40-50%), along with biologic and physiologic principles, led us to hypothesize that pulmonary HTN might be an additional risk factor for early graft dysfunction.
We performed a retrospective study that screened all adult renal transplants performed at our institution over a 3-year period and limited the evaluation to those subjects who had an estimated pulmonary artery systolic pressure on a preoperative echocardiogram report (n = 55). The primary outcome of this study was to investigate the impact of pulmonary HTN on early graft dysfunction using a combined endpoint of delayed graft function or slow graft function.
Among patients receiving a living donor kidney, early graft dysfunction was not observed regardless of pulmonary HTN status. However, among patients receiving a deceased donor kidney, pulmonary HTN was found to be associated with a significant increased risk of early graft dysfunction (56 vs 11.7%, P = 0.01). Univariate and multivariable logistic regression supported this observation as an independent risk factor beyond potential confounding recipient, donor and graft-based risk factors for early graft dysfunction (P < 0.05).
Pulmonary HTN detected on non-invasive imaging prior to renal transplantation appears to be an independent predictor of early graft dysfunction among those patients who receive a deceased donor kidney.
肾移植后早期移植物功能障碍是一种严重的并发症，是不良结局的标志。虽然以前已经描述了多种移植物功能障碍的预测因素，但透析人群中肺动脉高压（pulmonary HTN）的报告患病率（40-50%），以及生物学和生理学原理，使我们假设肺动脉高压可能是早期移植物功能障碍的另一个危险因素。
我们进行了一项回顾性研究，筛选了我们机构在 3 年内进行的所有成人肾移植，并将评估仅限于那些术前超声心动图报告中有估计肺动脉收缩压的患者（n = 55）。本研究的主要结局是使用延迟移植物功能或缓慢移植物功能的联合终点来研究肺动脉高压对早期移植物功能障碍的影响。
在接受活体供肾的患者中，无论肺动脉高压状态如何，均未观察到早期移植物功能障碍。然而，在接受已故供体肾的患者中，发现肺动脉高压与早期移植物功能障碍的风险显著增加相关（56%比 11.7%，P = 0.01）。单变量和多变量逻辑回归支持这一观察结果，表明在潜在混杂的受体、供体和移植物相关早期移植物功能障碍的危险因素之外，肺动脉高压是一个独立的危险因素（P < 0.05）。
在接受已故供体肾的患者中，在肾移植前非侵入性成像中检测到的肺动脉高压似乎是早期移植物功能障碍的独立预测因子。
