Brinza Crischentian, Covic Adrian, Stefan Anca Elena, Floria Mariana, Popa Iolanda Valentina, Scripcariu Dragos-Viorel, Burlacu Alexandru
Institute of Cardiovascular Diseases, 700503 Iasi, Romania.
Faculty of Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania.
J Clin Med. 2022 Mar 31;11(7):1944. doi: 10.3390/jcm11071944.
Pulmonary arterial hypertension (PH) has a high prevalence in chronic kidney disease (CKD) patients, especially those undergoing kidney transplantation (KT). We aimed to systematically review and calculate the pooled effect size of the literature evaluating the association between pre-existing PH documented by transthoracic echocardiography (TTE) or invasively and adverse outcomes following KT. The primary composite outcome extracted from the included studies was represented by the mortality from any cause following KT and delayed graft function (DGF), graft dysfunction, or graft failure. The secondary outcomes were represented by individual components of the primary composite outcome. Twelve studies meeting the inclusion criteria were selected. The main finding is that pre-existing PH was associated with increased mortality and a higher rate of DGF, kidney graft dysfunction, or failure in KT recipients. The effect remained significant for all outcomes irrespective of PH evaluation, invasively or using TTE. Consequently, patients with PH defined only by TTE were at higher risk of death, DGF, or graft failure. Our findings support the routine assessment of PH in patients on the KT waitlist. PH might represent an extensively available and valuable tool for risk stratification in KT patients. These data should be confirmed in large prospective clinical trials.
肺动脉高压（PH）在慢性肾脏病（CKD）患者中具有较高的患病率，尤其是那些接受肾移植（KT）的患者。我们旨在系统回顾并计算文献的合并效应量，以评估经胸超声心动图（TTE）记录的或通过侵入性检查记录的既往存在的PH与KT术后不良结局之间的关联。纳入研究中提取的主要复合结局以KT术后任何原因导致的死亡以及延迟移植肾功能（DGF）、移植肾功能障碍或移植失败来表示。次要结局由主要复合结局的各个组成部分表示。选择了12项符合纳入标准的研究。主要发现是，既往存在的PH与KT受者死亡率增加以及DGF、肾移植功能障碍或失败发生率较高相关。无论采用侵入性检查还是TTE评估PH，所有结局的效应均具有显著性。因此，仅通过TTE定义为PH的患者死亡、DGF或移植失败风险更高。我们的研究结果支持对KT等待名单上的患者进行PH的常规评估。PH可能是KT患者风险分层的一种广泛可用且有价值的工具。这些数据应在大型前瞻性临床试验中得到证实。
