Nguyen Michelle C, Po-Yu Chiang Teresa, Massie Allan B, Bae Sunjae, Motter Jennifer D, Brennan Daniel C, Desai Niraj M, Segev Dorry L, Garonzik-Wang Jacqueline M
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD.
Transplant Direct. 2021 Jul 23;7(8):e738. doi: 10.1097/TXD.0000000000001191. eCollection 2021 Aug.
Kidney transplantation (KT) is controversial in patients with pretransplant pulmonary hypertension (PtPH). We aimed to quantify post-KT graft and patient survival as well as survival benefit in recipients with PtPH.
Using UR Renal Data System (2000-2018), we studied 90 819 adult KT recipients. Delayed graft function, death-censored graft failure, and mortality were compared between recipients with and without PtPH using inverse probability weighted logistic and Cox regression. Survival benefit of KT was determined using stochastic matching and stabilized inverse probability treatment Cox regression.
Among 90 819 KT recipients, 2641 (2.9%) had PtPH. PtPH was associated with higher risk of delayed graft function (odds ratio, 1.23; 95% CI, 1.10-1.36; < 0.01), death-censored graft failure (hazard ratio [HR], 1.23; 95% CI, 1.11-1.38; < 0.01), and mortality (HR, 1.56; 95% CI, 1.44-1.69; < 0.01). However, patients with PtPH who received a KT had a 46% reduction in mortality (HR, 0.54; 95% CI, 0.48-0.61; < 0.01) compared with those who remained on the waitlist.
Although PtPH is associated with inferior post-KT outcomes, KT is associated with better survival compared with remaining on the waitlist. Therefore, KT is a viable treatment modality for appropriately selected patients with PtPH.
肾移植（KT）在移植前患有肺动脉高压（PtPH）的患者中存在争议。我们旨在量化肾移植后移植物和患者的生存率，以及PtPH受者的生存获益。
利用UR肾脏数据系统（2000 - 2018年），我们研究了90819名成年肾移植受者。使用逆概率加权逻辑回归和Cox回归比较了有和没有PtPH的受者之间的移植肾功能延迟、死亡删失的移植物失功和死亡率。使用随机匹配和稳定逆概率处理Cox回归确定肾移植的生存获益。
在90819名肾移植受者中，2641名（2.9%）患有PtPH。PtPH与移植肾功能延迟风险较高相关（比值比，1.23；95%置信区间，1.10 - 1.36；P < 0.01）、死亡删失的移植物失功（风险比[HR]，1.23；95%置信区间，1.11 - 1.38；P < 0.01）和死亡率（HR，1.56；95%置信区间，1.44 - 1.69；P < 0.01）。然而，与仍在等待名单上的患者相比，接受肾移植的PtPH患者死亡率降低了46%（HR，0.54；95%置信区间，0.48 - 0.61；P < 0.01）。
尽管PtPH与肾移植后较差的结局相关，但与仍在等待名单上相比，肾移植与更好的生存率相关。因此，对于适当选择的PtPH患者，肾移植是一种可行的治疗方式。
