Journal article
Incidence, Clinical Correlates, and Outcomes of Pulmonary Hypertension After Kidney Transplantation: Analysis of Linked US Registry and Medicare Billing Claims
Transplantation, Vol.106(3), pp.666-675
03/01/2022
DOI: 10.1097/TP.0000000000003783
PMID: 33859148
Abstract
The incidence, risks, and outcomes associated with pulmonary hypertension (P-HTN) in the kidney transplant (KTx) population are not well described.
We linked US transplant registry data with Medicare claims (2006-2016) to investigate P-HTN diagnoses among Medicare-insured KTx recipients (N = 35 512) using billing claims. Cox regression was applied to identify independent correlates and outcomes of P-HTN (adjusted hazard ratio [aHR] 95%LCLaHR95%UCL) and to examine P-HTN diagnoses as time-dependent mortality predictors.
Overall, 8.2% of recipients had a diagnostic code for P-HTN within 2 y preceding transplant. By 3 y posttransplant, P-HTN was diagnosed in 10.310.6%11.0 of the study cohort. After adjustment, posttransplant P-HTN was more likely in KTx recipients who were older (age ≥60 versus 18-30 y a HR, 1.912.403.01) or female (aHR, 1.151.241.34), who had pretransplant P-HTN (aHR, 4.384.795.24), coronary artery disease (aHR, 1.051.151.27), valvular heart disease (aHR, 1.221.321.43), peripheral vascular disease (aHR, 1.051.181.33), chronic pulmonary disease (aHR, 1.201.311.43), obstructive sleep apnea (aHR, 1.151.281.43), longer dialysis duration, pretransplant hemodialysis (aHR, 1.171.371.59), or who underwent transplant in the more recent era (2012-2016 versus 2006-2011: aHR, 1.291.391.51). Posttransplant P-HTN was associated with >2.5-fold increased risk of mortality (aHR, 2.572.843.14) and all-cause graft failure (aHR, 2.422.642.88) within 3 y posttransplant. Outcome associations of newly diagnosed posttransplant P-HTN were similar.
Posttransplant P-HTN is diagnosed in 1 in 10 KTx recipients and is associated with an increased risk of death and graft failure. Future research is needed to refine diagnostic, classification, and management strategies to improve outcomes in KTx recipients who develop P-HTN.
Details
- Title: Subtitle
- Incidence, Clinical Correlates, and Outcomes of Pulmonary Hypertension After Kidney Transplantation: Analysis of Linked US Registry and Medicare Billing Claims
- Creators
- Krista L Lentine - Saint Louis UniversityNgan N Lam - University of CalgaryYasar Caliskan - Saint Louis UniversityHuiling Xiao - Saint Louis UniversityDavid A Axelrod - University of IowaSalvatore P Costa - Dartmouth–Hitchcock Medical CenterDeborah J Levine - UT Health, San Antonio, TX.James R Runo - University of Wisconsin–MadisonHelen S Te - University of ChicagoJanani Rangaswami - Einstein Medical Center PhiladelphiaDarshana M Dadhania - Weill Cornell MedicineMark A Schnitzler - Saint Louis UniversityBertram L Kasiske - Hennepin County Medical CenterTodd C Villines - University of Virginia
- Resource Type
- Journal article
- Publication Details
- Transplantation, Vol.106(3), pp.666-675
- DOI
- 10.1097/TP.0000000000003783
- PMID
- 33859148
- NLM abbreviation
- Transplantation
- ISSN
- 0041-1337
- eISSN
- 1534-6080
- Grant note
- HHSH250201000018C / HHS R01 DK120518 / NIDDK NIH HHS
- Language
- English
- Date published
- 03/01/2022
- Academic Unit
- Surgery
- Record Identifier
- 9984322794002771
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