title: Pulmonary hypertension is associated with reduced patient survival after kidney transplantation.
abstract: BACKGROUND
  Pulmonary hypertension (PH) is common in patients on dialysis where it is associated with reduced survival. The possible association between PH and kidney transplant recipient survival has not been previously evaluated.
  
  
  METHODS
  In this retrospective study, we screened for PH pretransplant in 215 transplant candidates using cardiac echocardiography and measurements of right ventricular systolic pressure (RVSP).
  
  
  RESULTS
  Sixty-eight percent of patients had normal RVSP (<35 mm Hg), 47 (22%) had mild to moderately elevated RVSP (36-50), and 22 (10%) had markedly elevated RVSP more than 50 suggestive of severe PH. Time on dialysis was the strongest correlate of an elevated RVSP (r=0.253, P<0.001) and this relationship was independent of other variables. Elevated RVSP was observed in 25%, 25%, 38%, and 58% of patients not on dialysis, on dialysis for less than 1 year, more than 1 to 2 years, or more than 2 years, respectively. An RVSP more than 50 was associated with significantly reduced posttransplant survival (hazard ratio =3.75 [1.17-11.97], P=0.016). This relationship seemed to be independent of other variables including older age, reduced left ventricular ejection fraction, low serum albumin, and delayed graft function.
  
  
  CONCLUSIONS
  These analyses suggest for the first time that pretransplant PH correlates with patient survival after kidney transplantation.
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Naim
authors.initials: N
authors.lastname: Issa
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Krowka
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Griffin
authors.forename: LaTonya J
authors.initials: LJ
authors.lastname: Hickson
authors.forename: Mark D
authors.initials: MD
authors.lastname: Stegall
authors.forename: Fernando G
authors.initials: FG
authors.lastname: Cosio
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D011300:Preoperative Care; D006435:Renal Dialysis / Q000009:adverse effects; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors; D013599:Systole; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000401:mortality