Researchers have identified important considerations and management strategies for patients with pulmonary hypertension (PH) undergoing kidney transplantation due to chronic kidney disease. The study, published in the Turkish Journal of Nephrology, highlights the need to tailor management strategies based on the specific type of PH. PH is categorized into five groups, with Group 5 increasingly associated with systemic disorders like chronic kidney disease. This association has significant implications for pre- and post-transplant outcomes.
The researchers emphasize the importance of conducting echocardiograms at three months post-transplant and annually or biennially thereafter for patients with a history of elevated pulmonary pressures. If elevated pressures persist, right heart catheterization may be considered. The researchers stress the need to define the underlying cause of PH before initiating targeted therapy and highlight the different management strategies for Group 1 PH (pulmonary arterial hypertension) compared to Groups 2-5. The study also provides personalized treatment approaches for patients with PH, including anticoagulation, calcium channel blockers, and targeted therapies depending on the specific group.
For patients with Group 2 PH, PAH-focused treatment is not recommended, and management strategies should follow the American College of Cardiology and American Heart Association guidelines. Patients with Group 3 PH may require oxygen therapy, while those with Group 4 PH may benefit from anticoagulation and thrombectomy, with considerations for surgical risks. The complications and outcomes of PH in kidney transplant patients are complex, and an individualized approach is necessary.
