Association of Cardiopulmonary Hemodynamics and Outcomes in Pulmonary Hypertension Following Kidney Transplantation: A Multicenter Retrospective Cohort Study.

Background: Pulmonary hypertension (PH) frequently complicates the evaluation of kidney transplantation (KT) candidates, and is associated with increased adverse outcomes (mortality, delayed graft function [DGF], and major adverse cardiovascular event) following KT.

Research Question: What is the relationship between cardiopulmonary hemodynamics and post-KT outcomes?

Study Design And Methods: We conducted a multicenter retrospective cohort study of adults undergoing KT between October 1, 2011 and October 1, 2021, who underwent right heart catheterization (RHC) to assess cardiopulmonary hemodynamics within 1 year of transplantation. Frailty models and logistic regression models were used to evaluate the association between cardiopulmonary hemodynamics and outcomes (mortality, DGF, major adverse cardiovascular event) following KT.

Results: A total of 117 patients were included in the final analysis, predominantly male (72%), with a median age of 57 years. PH, defined as mean pulmonary artery pressure (mPAP) > 20 mm Hg, was present in most of the cohort (n = 93; 79%). The cohort was monitored for a median of 29.9 months post-KT, during which about one-fourth experienced mortality (23%) or DGF (25%) events, and approximately one-third (34%) experienced major adverse cardiovascular event. Although echocardiographic measures of pulmonary artery pressure failed to identify post-KT outcomes, a mPAP of ≥ 30 mm Hg on RHC was associated with post-KT major adverse cardiovascular event (hazard ratio, 2.60; 95% CI, 1.10-6.10) and more prevalent in those experiencing post-KT mortality (63% vs 32%; P = .001). Precapillary pulmonary hypertension was also associated with post-KT mortality (hazard ratio, 3.71; 95% CI, 1.07-12.90).

Interpretation: Precapillary pulmonary hypertension and an mPAP of ≥ 30 mm Hg on RHC, but not echocardiographic evidence of PH, was associated with mortality and major adverse cardiovascular event following KT. These data suggest that RHC hemodynamics are superior to echocardiographic measures of PH in association with outcomes following KT, and RHC-derived mPAP in particular may have value in predicting major adverse cardiovascular event and mortality post-KT.