Lentine Krista L, Lam Ngan N, Caliskan Yasar, Xiao Huiling, Axelrod David A, Costa Salvatore P, Levine Deborah J, Runo James R, Te Helen S, Rangaswami Janani, Dadhania Darshana M, Schnitzler Mark A, Kasiske Bertram L, Villines Todd C
Center for Abdominal Transplantation, Saint Louis University, School of Medicine, St Louis, MO.
University of Calgary, Calgary, AB, Canada.
Transplantation. 2022 Mar 1;106(3):666-675. doi: 10.1097/TP.0000000000003783.
The incidence, risks, and outcomes associated with pulmonary hypertension (P-HTN) in the kidney transplant (KTx) population are not well described.
We linked US transplant registry data with Medicare claims (2006-2016) to investigate P-HTN diagnoses among Medicare-insured KTx recipients (N = 35 512) using billing claims. Cox regression was applied to identify independent correlates and outcomes of P-HTN (adjusted hazard ratio [aHR] 95%LCLaHR95%UCL) and to examine P-HTN diagnoses as time-dependent mortality predictors.
Overall, 8.2% of recipients had a diagnostic code for P-HTN within 2 y preceding transplant. By 3 y posttransplant, P-HTN was diagnosed in 10.310.6%11.0 of the study cohort. After adjustment, posttransplant P-HTN was more likely in KTx recipients who were older (age ≥60 versus 18-30 y a HR, 1.912.403.01) or female (aHR, 1.151.241.34), who had pretransplant P-HTN (aHR, 4.384.795.24), coronary artery disease (aHR, 1.051.151.27), valvular heart disease (aHR, 1.221.321.43), peripheral vascular disease (aHR, 1.051.181.33), chronic pulmonary disease (aHR, 1.201.311.43), obstructive sleep apnea (aHR, 1.151.281.43), longer dialysis duration, pretransplant hemodialysis (aHR, 1.171.371.59), or who underwent transplant in the more recent era (2012-2016 versus 2006-2011: aHR, 1.291.391.51). Posttransplant P-HTN was associated with >2.5-fold increased risk of mortality (aHR, 2.572.843.14) and all-cause graft failure (aHR, 2.422.642.88) within 3 y posttransplant. Outcome associations of newly diagnosed posttransplant P-HTN were similar.
Posttransplant P-HTN is diagnosed in 1 in 10 KTx recipients and is associated with an increased risk of death and graft failure. Future research is needed to refine diagnostic, classification, and management strategies to improve outcomes in KTx recipients who develop P-HTN.
肾移植（KTx）人群中肺动脉高压（P-HTN）的发病率、风险及相关结局尚未得到充分描述。
我们将美国移植登记数据与医疗保险理赔数据（2006 - 2016年）相链接，以使用计费理赔数据调查医疗保险覆盖的KTx受者（N = 35512）中的P-HTN诊断情况。应用Cox回归来确定P-HTN的独立相关因素和结局（调整后风险比[aHR] 95%置信区间下限[aHR95%LCL] - aHR95%置信区间上限[aHR95%UCL]），并将P-HTN诊断作为时间依赖性死亡预测因素进行检验。
总体而言，8.2%的受者在移植前2年内有P-HTN诊断代码。移植后3年时，研究队列中有10.3% - 10.6% - 11.0%的受者被诊断为P-HTN。调整后，移植后P-HTN在年龄较大（年龄≥60岁与18 - 30岁相比：aHR，1.91 - 2.40 - 3.01）或女性（aHR，1.15 - 1.24 - 1.34）、移植前有P-HTN（aHR，4.38 - 4.79 - 5.24）、冠状动脉疾病（aHR，1.05 - 1.15 - 1.27）、心脏瓣膜病（aHR，1.22 - 1.32 - 1.43）、外周血管疾病（aHR，1.05 - 1.18 - 1.33）、慢性肺部疾病（aHR，1.20 - 1.31 - 1.43）、阻塞性睡眠呼吸暂停（aHR，1.15 - 1.28 - 1.43）、透析时间较长、移植前接受血液透析（aHR，1.17 - 1.37 - 1.59）或在较近期（2012 - 2016年与2006 - 2011年相比：aHR，1.29 - 1.39 - 1.51）接受移植的KTx受者中更常见。移植后P-HTN与移植后3年内死亡风险增加>2.5倍（aHR，2.57 - 2.84 - 3.14）和全因移植失败风险增加（aHR，2.42 - 2.64 - 2.88）相关。新诊断的移植后P-HTN的结局关联相似。
每10名KTx受者中有1人被诊断为移植后P-HTN，且与死亡和移植失败风险增加相关。需要进一步研究以完善诊断、分类和管理策略，从而改善发生P-HTN的KTx受者的结局。
