Association of pre-transplant pulmonary hypertension and post-transplant major adverse cardiovascular events in kidney transplant recipients: a retrospective study.

BACKGROUND

Pulmonary hypertension (PH) frequently complicates end-stage kidney disease, contributing significantly to cardiovascular morbidity and mortality. Some of the pathophysiologic effects of PH may persist even after kidney transplantation (KT). We investigated the association between pre-transplant PH and long-term major adverse cardiovascular events (MACE) after KT.

METHODS

This retrospective cohort study included 468 adult KT recipients from an academic medical center between January 2015 and January 2024. We excluded patients who did not follow up at our institution and those with no adequate pre-transplant assessment of pulmonary artery (PA) pressures. Patients were stratified based on the presence of pre-transplant PH, defined as PA systolic pressure > 35 mmHg on echocardiography or mean PA pressure > 20 mmHg via right heart catheterization. The primary outcome was the occurrence of MACE after KT, defined as cardiovascular death, nonfatal myocardial infarction, stroke, or hospitalization for heart failure. Kaplan-Meier cumulative incidence curves and Multivariable Cox proportional hazards models were used.

RESULTS

Of the 468 recipients who qualified for the study, 86 (18.4%) had pre-transplant PH. Over a mean follow-up of 54.7 ± 28.4 months, 89 patients (19.0%) experienced MACE. The incidence of MACE was significantly higher in the PH group at one- (8.1 vs 2.9%, p = 0.03) and five-year (22.0 vs 11.0%, p = 0.01). After adjusting for age, sex, and relevant confounders, PH remained independently associated with MACE (HR 2.15; 95% CI 1.25-3.70; p = 0.01).

CONCLUSIONS

In this retrospective single-center study, pre-transplant PH was independently associated with an increased risk for MACE following KT. These findings highlight the importance of identifying PH in KT candidates. Enhanced cardiovascular risk surveillance may be warranted in this population.

TRIAL REGISTRATION: Not applicable as this is a retrospective cohort study.