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Review
. 2022 Mar 31;11(7):1944.
doi: 10.3390/jcm11071944.

Pulmonary Arterial Hypertension and Adverse Outcomes after Kidney Transplantation: A Systematic Review and Meta-Analysis

Crischentian Brinza  1   2 , Adrian Covic  2   3 , Anca Elena Stefan  3 , Mariana Floria  2   4 , Iolanda Valentina Popa  2 , Dragos-Viorel Scripcariu  2 , Alexandru Burlacu  1   2
Affiliations
Review

Pulmonary Arterial Hypertension and Adverse Outcomes after Kidney Transplantation: A Systematic Review and Meta-Analysis

Crischentian Brinza et al. J Clin Med. .

Abstract

Pulmonary arterial hypertension (PH) has a high prevalence in chronic kidney disease (CKD) patients, especially those undergoing kidney transplantation (KT). We aimed to systematically review and calculate the pooled effect size of the literature evaluating the association between pre-existing PH documented by transthoracic echocardiography (TTE) or invasively and adverse outcomes following KT. The primary composite outcome extracted from the included studies was represented by the mortality from any cause following KT and delayed graft function (DGF), graft dysfunction, or graft failure. The secondary outcomes were represented by individual components of the primary composite outcome. Twelve studies meeting the inclusion criteria were selected. The main finding is that pre-existing PH was associated with increased mortality and a higher rate of DGF, kidney graft dysfunction, or failure in KT recipients. The effect remained significant for all outcomes irrespective of PH evaluation, invasively or using TTE. Consequently, patients with PH defined only by TTE were at higher risk of death, DGF, or graft failure. Our findings support the routine assessment of PH in patients on the KT waitlist. PH might represent an extensively available and valuable tool for risk stratification in KT patients. These data should be confirmed in large prospective clinical trials.

Keywords: adverse outcomes; kidney transplantation; meta-analysis; prediction; pulmonary arterial hypertension.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of selected studies in present analysis.
Figure 2
Figure 2
(A) Primary composite outcome (mortality from any cause following KT and delayed graft function (DGF), graft dysfunction, or graft failure). (B) Primary composite outcome estimated by TTE only. (C) Primary composite outcome estimated by PASP–TTE.
Figure 2
Figure 2
(A) Primary composite outcome (mortality from any cause following KT and delayed graft function (DGF), graft dysfunction, or graft failure). (B) Primary composite outcome estimated by TTE only. (C) Primary composite outcome estimated by PASP–TTE.
Figure 3
Figure 3
(A) Graft dysfunction or failure. (B) Graft dysfunction or failure estimated by TTE only. (C) Delayed graft function or failure estimated by PASP–TTE only.
Figure 4
Figure 4
(A) Mortality. (B) Mortality estimated by TTE only. (C) Mortality estimated by PASP–TTE only.
Figure 5
Figure 5
Funnel plot.
See this image and copyright information in PMC

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