Scalia Isabel G, Farina Juan M, Pietri Milagros Pereyra, Ali Nima Baba, Abbas Mohammed Tiseer, Awad Kamal, Mahmoud Ahmed K, Javadi Niloofar, Bismee Nadera N, Riad Samy, Wadei Hani, Smith Byron, Steidley D Eric, Barry Timothy, Scott Robert L, Cho Yeoungjee, Johnson David W, Ayoub Chadi, Arsanjani Reza, Mour Girish
Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona, USA.
Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Kidney Int Rep. 2025 May 6;10(7):2394-2404. doi: 10.1016/j.ekir.2025.04.058. eCollection 2025 Jul.
Pulmonary hypertension (PHTN) in patients with kidney failure is known to be associated with increased morbidity and mortality. Despite this, there is a relative paucity of large cohort data regarding its clinical impact following kidney transplantation (KTx). Therefore, this study sought to directly evaluate the prognostic implications of pretransplant PHTN in one of the largest kidney transplant cohorts to date.
This retrospective observational cohort analysis reviewed all consecutive kidney transplant recipients at three tertiary transplant centers in the United States between January 1, 2011 and September 30, 2021. Pretransplant PHTN was defined as right ventricular systolic pressure (RVSP) ≥ 35 mm Hg on transthoracic echocardiography (TTE). Clinical outcomes were compared between patients with and without pretransplant PHTN, including mortality and allograft failure (overall and censored by mortality).
A total of 5322 KTx recipients were included; mean age 55.2 ± 13.7 years, 58.8% male. Of these patients, 1726 (32.4%) had pretransplant PHTN. PHTN was independently associated with significantly poorer outcomes: mortality (adjusted hazard ratio [aHR]: 1.24, 95% confidence interval [CI]: 1.06-1.45, = 0.007), overall allograft failure (aHR 1.24, 95% CI: 1.09-1.42, = 0.002), and death-censored allograft loss (aHR: 1.25, 95% CI: 1.01-1.56, = 0.044). Risk of mortality and overall allograft failure also appeared to be incrementally higher with increasing pulmonary pressures.
Pretransplant PHTN classified by echocardiographic RVSP was independently and incrementally associated with an increased risk of mortality and allograft failure post-KTx. In pretransplant work up, this may allow for identification of a high-risk cohort that could benefit from further evaluation, early intervention, and closer surveillance in the posttransplant period.
已知肾衰竭患者的肺动脉高压（PHTN）与发病率和死亡率增加相关。尽管如此，关于肾移植（KTx）后其临床影响的大型队列数据相对较少。因此，本研究旨在直接评估移植前PHTN在迄今为止最大的肾移植队列之一中的预后意义。
这项回顾性观察性队列分析回顾了2011年1月1日至2021年9月30日期间美国三个三级移植中心的所有连续肾移植受者。移植前PHTN定义为经胸超声心动图（TTE）测得的右心室收缩压（RVSP）≥35mmHg。比较了有和没有移植前PHTN的患者的临床结局，包括死亡率和移植物失败（总体以及按死亡率进行审查）。
共纳入5322名KTx受者；平均年龄55.2±13.7岁，58.8%为男性。在这些患者中，1726名（32.4%）有移植前PHTN。PHTN与明显更差的结局独立相关：死亡率（调整后风险比[aHR]：1.24，95%置信区间[CI]：1.06 - 1.45，P = 0.007）、总体移植物失败（aHR 1.24，95% CI：1.09 - 1.42，P = 0.002）以及死亡审查后的移植物丢失（aHR：1.25，95% CI：1.01 - 1.56，P = 0.044）。随着肺压力升高，死亡率和总体移植物失败的风险似乎也逐渐增加。
通过超声心动图RVSP分类的移植前PHTN与KTx后死亡率和移植物失败风险增加独立且逐步相关。在移植前评估中，这可能有助于识别出一个高危队列，该队列可能从移植后进一步评估、早期干预和密切监测中获益。
