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. 2022 Mar 1;106(3):666-675.
doi: 10.1097/TP.0000000000003783.

Incidence, Clinical Correlates, and Outcomes of Pulmonary Hypertension After Kidney Transplantation: Analysis of Linked US Registry and Medicare Billing Claims

Krista L Lentine  1 , Ngan N Lam  2 , Yasar Caliskan  1 , Huiling Xiao  1 , David A Axelrod  3 , Salvatore P Costa  4 , Deborah J Levine  5 , James R Runo  6 , Helen S Te  7 , Janani Rangaswami  8 , Darshana M Dadhania  9 , Mark A Schnitzler  1 , Bertram L Kasiske  10 , Todd C Villines  11
Affiliations

Incidence, Clinical Correlates, and Outcomes of Pulmonary Hypertension After Kidney Transplantation: Analysis of Linked US Registry and Medicare Billing Claims

Krista L Lentine et al. Transplantation. .

Abstract

Background: The incidence, risks, and outcomes associated with pulmonary hypertension (P-HTN) in the kidney transplant (KTx) population are not well described.

Methods: We linked US transplant registry data with Medicare claims (2006-2016) to investigate P-HTN diagnoses among Medicare-insured KTx recipients (N = 35 512) using billing claims. Cox regression was applied to identify independent correlates and outcomes of P-HTN (adjusted hazard ratio [aHR] 95%LCLaHR95%UCL) and to examine P-HTN diagnoses as time-dependent mortality predictors.

Results: Overall, 8.2% of recipients had a diagnostic code for P-HTN within 2 y preceding transplant. By 3 y posttransplant, P-HTN was diagnosed in 10.310.6%11.0 of the study cohort. After adjustment, posttransplant P-HTN was more likely in KTx recipients who were older (age ≥60 versus 18-30 y a HR, 1.912.403.01) or female (aHR, 1.151.241.34), who had pretransplant P-HTN (aHR, 4.384.795.24), coronary artery disease (aHR, 1.051.151.27), valvular heart disease (aHR, 1.221.321.43), peripheral vascular disease (aHR, 1.051.181.33), chronic pulmonary disease (aHR, 1.201.311.43), obstructive sleep apnea (aHR, 1.151.281.43), longer dialysis duration, pretransplant hemodialysis (aHR, 1.171.371.59), or who underwent transplant in the more recent era (2012-2016 versus 2006-2011: aHR, 1.291.391.51). Posttransplant P-HTN was associated with >2.5-fold increased risk of mortality (aHR, 2.572.843.14) and all-cause graft failure (aHR, 2.422.642.88) within 3 y posttransplant. Outcome associations of newly diagnosed posttransplant P-HTN were similar.

Conclusions: Posttransplant P-HTN is diagnosed in 1 in 10 KTx recipients and is associated with an increased risk of death and graft failure. Future research is needed to refine diagnostic, classification, and management strategies to improve outcomes in KTx recipients who develop P-HTN.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Hart A, Lentine KL, Smith JM, et al. OPTN/SRTR 2019 annual data report: kidney. Am J Transplant. 2021;21(Suppl 2):21–137.
    1. Axelrod DA, Schnitzler MA, Xiao H, et al. An economic assessment of contemporary kidney transplant practice. Am J Transplant. 2018;18:1168–1176.
    1. Lentine KL, Gheorghian A, Axelrod D, et al. The implications of acute rejection for allograft survival in contemporary U.S. kidney transplantation. Transplantation. 2012;94:369–376.
    1. Schnitzler MA, Lentine KL, Gheorghian A, et al. Renal function following living, standard criteria deceased and expanded criteria deceased donor kidney transplantation: impact on graft failure and death. Transpl Int. 2012;25:179–191.
    1. Lentine KL, Hurst FP, Jindal RM, et al. Cardiovascular risk assessment among potential kidney transplant candidates: approaches and controversies. Am J Kidney Dis. 2010;55:152–167.

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