Abstract 13753: Pulmonary Hypertension in Renal Transplant Candidates: Can Hemodynamic Profiles Help Provide Insights for Therapeutic Options?
Background: The prevalence of pulmonary hypertension (pulmonary HTN) in patients with end stage renal disease has been estimated to be 40-50% using noninvasive techniques, and this finding has been demonstrated to be a risk factor for increased morbidity and mortality in the renal transplant (RT) population. We sought to further classify these patients based on invasive hemodynamics.
Methods: We retrospectively identified twelve RT candidates over a five year period (2006-2011) who were found to have a pulmonary artery systolic pressure ≥ 40 mmHg on noninvasive testing with echocardiography and underwent a subsequent right heart catheterization prior to transplant. Patient categories were created based on hemodynamic profiles (see below). The electronic medical record was reviewed to obtain demographic, echocardiographic, and hemodynamic data.
Results: All patients were on dialysis and had an arteriovenous fistula (AV fistula). Eleven of the twelve RT candidates were found to have a mean pulmonary artery pressure ≥ 25 mmHg during right heart catheterization consistent with pulmonary HTN. Of these eleven patients, three primary hemodynamic patterns emerged: 1) Two patients with high pulmonary vascular resistance (PVR ≥ 3 Woods units), 2) Six patients with high cardiac output with or without elevated left-sided pressures, 3) Three patients with elevated left-sided pressures (PCWP ≥ 18 mmHg) in the absence of high cardiac output. See table for details (all values expressed as mean).
Conclusions: Although noninvasive testing can help identify the presence of pulmonary HTN in RT candidates, invasive testing is necessary to classify these patients based on hemodynamic profiles to provide targeted therapies (i.e. vasodilators, AV fistula banding, and optimal volume management) which may improve outcomes in this patient population.
- © 2011 by American Heart Association, Inc.