The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701).
Background
Severe pulmonary hypertension (PH) has been associated with decreased post–kidney transplant survival and increased rate of long‐term cardiovascular complications. Despite a high prevalence of PH in patients with end‐stage renal disease, data on post‐transplant renal allograft survival in recipients with pre‐existing mild‐to‐moderate PH are limited.
Methods
The single‐center retrospective study cohort consisted of 192 consecutive (2008–2015) renal transplant recipients with documented pretransplantation transthoracic echocardiogram (TTE) pulmonary artery systolic pressure (PASP). Mean age was 50.9 ± 12.4 years, 36.5% were females, and 81.25% were Caucasians.
Results
Elevated PASP ≥ 37 mm Hg was present in 51 patients. Elevated PASP was more common in patients with decreased <50% left ventricular ejection fraction (13.73% vs 3.55%, P = 0.010); otherwise, there were no significant differences in baseline demographic (age, ethnicity, gender, and donor status) and clinical parameters between patients with normal and elevated PASP. Four‐year mortality (5.7%) was not significantly affected by elevated PASP. However, elevated PASP was associated with significantly decreased estimated glomerular filtration rate (eGFR) at 1 year (52.26 vs 60.13 mL/min, P = 0.019) and 2 years (51.04 vs 60.28 mL/min, P = 0.006) post‐transplant.
Conclusion
Mild and moderately elevated pre–kidney transplant PASP does not affect 4‐year post‐transplant mortality or graft loss. However, elevated pretransplant PASP is significantly associated with decreased 1 year and 2 years post‐transplant eGFR. Preoperative echocardiographic evaluation for PH may be useful in predicting the probability of short‐term renal graft and long‐term graft dysfunction in these patients.
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