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Pulmonary hypertension (PH) is often present in patients presenting for kidney transplant listing. While PH can complicate kidney transplantation (KTx), it can be managed with multidisciplinary management that includes both the transplant center and pulmonary hypertension center, or with experts both pre- and post-transplant. This review summarizes the approach and management of PH in KTx candidates and recipients, along with expected outcomes and controversies surrounding arteriovenous fistula and graft management.