Pulmonary hypertension is associated with increased risk for graft dysfunction after kidney transplantation, investigators report.

Among 350 patients who received a single kidney transplant from 2010 to 2011 at Emory Transplant Center in Atlanta, Georgia, 117 (33%) had preoperative pulmonary hypertension based on echocardiography. The composite risk for death, graft dysfunction, or graft failure at 5 years after kidney transplantation was significantly higher among patients with than without pulmonary hypertension: 66% vs 45%, a team led by Aaron Trammell, MD, of Emory University School of Medicine, reported in Pulmonary Circulation.  In a multivariable analysis, pretransplant pulmonary hypertension was associated with a 43% increased relative risk for the composite outcome. Risk was highest among patients with moderate to severe pulmonary hypertension. Ten percent of kidney transplant recipients died, but there was no rate difference between groups.

Pulmonary hypertension, a frequent result of chronically elevated pulmonary venous pressures, is common in chronic kidney disease and end-stage kidney disease (ESKD), the investigators noted.

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“Patients with [pulmonary hypertension] should not be disregarded from consideration of kidney transplantation as an available treatment option for advanced CKD and [ESKD],” Dr Trammell’s team wrote. “The known benefits of improved quality and quantity of life afforded by kidney transplantation likely outweigh the marginal increased risk of graft dysfunction at 5 years demonstrated in our study population.”


Rabih F, Holden RL, Vasanth P, et al. Effect of pulmonary hypertension on 5-year outcome of kidney transplantation. Pulmonary Circulation. Published online January 3, 2022. doi:10.1002/pul2.12010