Pulmonary hypertension in kidney transplant candidates and recipients

A recent paper in Transplantation provides recommendations on evaluation and management of pulmonary hypertension (PH) in those being worked up for or have received kidney transplantation. About 20-40%, or even more, of all patients may have pulmonary hypertension due to different reasons.

Given below are the important concepts that help in understanding the pathogenesis of this condition, some controversies and concept, and suggested guidelines for evaluation and management.

  • Current classification of PH is based on cardiopulmonary and hemodynamic abnormalities that are common among kidney transplant candidates
  • Classifying PH in patients with kidney failure is challenging but must be pursued for optimal management
  • PH is common and clinically significant among kidney transplant candidates
  • Estimates of PH among kidney transplant candidates have been based on imprecise diagnostic methods
  • PH has been associated with adverse outcomes after kidney transplantation
  • PH is not always associated with adverse outcomes and transplantation may resolve elevated pulmonary pressures
  • Recent advances in the treatment of PH in the general population focus on group 1 disease
  • The efficacy of treatments for PH in patients with ESRD before and after transplantation are unproven

Understanding the pathogenesis of PH*

PH Pathogenesis

*Red boxed indicate risk factors

AHA/ACCF Recommendations for the Evaluation of Pulmonary Hypertension Among Kidney Transplant Candidates

Fig 3

 

How to evaluate a patient suspected to have PH

Fig 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current management strategies for PH 

PH pathogenesis

Source:

Lentine KL, Villines TC, Axelrod D, Kaviratne S, Weir MR, Costa SP. Evaluation and Management of Pulmonary Hypertension in Kidney Transplant Candidates and Recipients: 
Concepts and Controversies. Transplantation. 2016 Mar 16. [Epub ahead of print] PubMed PMID: 26985742.

 

 

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