Rabih Fadi, Holden Rhiannon L, Vasanth Payaswini, Pastan Stephen O, Fisher Micah R, Trammell Aaron W
Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine Emory University School of Medicine Atlanta Georgia USA.
Department of Medicine, Division of Renal Medicine Emory University School of Medicine Atlanta Georgia USA.
Pulm Circ. 2022 Jan 3;12(1):e12010. doi: 10.1002/pul2.12010. eCollection 2022 Jan.
Pulmonary hypertension affects about one in four patients with advanced chronic kidney disease and significantly increases the risk of death. Kidney transplantation is the recommended management option for patients with progressive or end-stage kidney disease. However, the resource-limited nature of kidney transplantation and its intensive peri-operative and posttransplantation management motivates careful consideration of potential candidates' medical conditions to optimally utilize available graft organs. Since pulmonary hypertension is known to increase peri-operative morbidity and mortality among patients living with chronic kidney disease, we performed a retrospective cohort study to assess the impact of pretransplantation pulmonary hypertension on posttransplantation outcome. All patients who underwent single-organ kidney transplantation at our center in calendar years 2010 and 2011 were identified and the presence of pulmonary hypertension was determined from pretransplantation echocardiography. Outcome was assessed at 5 years following kidney transplantation. Of 350 patients who were included, 117 (33%) had evidence of pulmonary hypertension. The risk of death, graft dysfunction, or graft failure at 5 years after kidney transplantation was higher among those with pulmonary hypertension, primarily owing to an increased risk of graft dysfunction. Importantly, in this institutional cohort of kidney transplant recipients, pretransplant pulmonary hypertension was not associated with a difference in posttransplant survival at 5 years. While institutional and regional differences in outcome can be expected, this report suggests that carefully selected patients with pulmonary hypertension receive similar long-term benefits from kidney transplantation.
肺动脉高压影响约四分之一的晚期慢性肾病患者，并显著增加死亡风险。肾移植是进展性或终末期肾病患者推荐的治疗选择。然而，肾移植资源有限的性质及其围手术期和移植后强化管理促使我们仔细考虑潜在受者的医疗状况，以优化可用移植器官的利用。由于已知肺动脉高压会增加慢性肾病患者围手术期的发病率和死亡率，我们进行了一项回顾性队列研究，以评估移植前肺动脉高压对移植后结局的影响。我们确定了2010年和2011年在本中心接受单器官肾移植的所有患者，并通过移植前超声心动图确定是否存在肺动脉高压。在肾移植后5年评估结局。在纳入的350例患者中，117例（33%）有肺动脉高压证据。肾移植后5年，肺动脉高压患者的死亡、移植物功能障碍或移植物失败风险更高，主要是由于移植物功能障碍风险增加。重要的是，在这个肾移植受者的机构队列中，移植前肺动脉高压与5年后移植后生存率的差异无关。虽然预期结局存在机构和地区差异，但本报告表明，经过精心挑选的肺动脉高压患者从肾移植中可获得相似的长期益处。
