TY - JOUR
T1 - Kidney Transplantation Confers Survival Benefit for Candidates With Pulmonary Hypertension
AU - Nguyen, Michelle C.
AU - Po-Yu Chiang, Teresa
AU - Massie, Allan B.
AU - Bae, Sunjae
AU - Motter, Jennifer D.
AU - Brennan, Daniel C.
AU - Desai, Niraj M.
AU - Segev, Dorry L.
AU - Garonzik-Wang, Jacqueline M.
N1 - Funding Information:
This work was supported by grant numbers K24DK101828, K01DK101677, and K23DK115908-01 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Publisher Copyright:
© 2021 The Authors(s).
PY - 2021/7/23
Y1 - 2021/7/23
N2 - Background. 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. Methods. 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. Results. 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; P < 0.01), death-censored graft failure (hazard ratio [HR], 1.23; 95% CI, 1.11-1.38; P < 0.01), and mortality (HR, 1.56; 95% CI, 1.44-1.69; P < 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; P < 0.01) compared with those who remained on the waitlist. Conclusions. 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.
AB - Background. 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. Methods. 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. Results. 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; P < 0.01), death-censored graft failure (hazard ratio [HR], 1.23; 95% CI, 1.11-1.38; P < 0.01), and mortality (HR, 1.56; 95% CI, 1.44-1.69; P < 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; P < 0.01) compared with those who remained on the waitlist. Conclusions. 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.
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U2 - 10.1097/TXD.0000000000001191
DO - 10.1097/TXD.0000000000001191
M3 - Article
C2 - 35836668
AN - SCOPUS:85112391328
SN - 2373-8731
VL - 7
SP - E738
JO - Transplantation Direct
JF - Transplantation Direct
IS - 8
ER -