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J Thorac Cardiovasc Surg 2007;133:1212-1219
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Perioperative outcomes of cardiac surgery in kidney and kidney–pancreas transplant recipients

Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn.

Read at the Thirty-second Annual Meeting of the Western Thoracic Surgical Association, Sun Valley, Idaho, June 21-24, 2006.

Received for publication June 22, 2006; revisions received November 15, 2006; accepted for publication November 28, 2006.

^_* Address for reprints: Ranjit John, MD, Assistant Professor, Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN 55455. (Email: johnx008{at}umn.edu).

Objective: Cardiovascular disease is a common cause of morbidity and mortality in organ transplant recipients, and cardiac surgery has become more common in this population. We performed a retrospective study of kidney transplant recipients who underwent cardiac surgery over the past 10 years at our institution with an emphasis on evaluating postoperative outcomes.

Methods: Seventy-four patients with previous abdominal transplants underwent cardiac surgery (93% coronary artery bypass grafting, 5.4% bypass grafting plus valve, and 1.4% valve) between 1995 and 2005. These recipients were compared with 895 adult nontransplant patients undergoing cardiac surgery between 2000 and 2005. Only kidney and kidney–pancreas recipients were included in the analysis (n = 70) because there were only 2 liver and pancreas alone transplants.

Results: As compared with nontransplant patients, kidney transplant patients were younger (mean age 52.1 ± 10 years vs 61 ± 13 years; P < .001) and had an increased incidence of diabetes (92.9% vs 39.1%; P < .001), peripheral vascular disease (37.1% vs 19.1%; P < .001), chronic kidney insufficiency (73.0% vs 13.4%; P < 0.001), and unstable angina (44.8% vs 25.7%; P = .005) There was no difference between the two groups in the complication rate at 30 days after surgery, except that transplant patients were more likely to have postoperative kidney dysfunction (32.6% vs 6.1%; P < .001) and require hemodialysis (11.7% vs 1.1%; P < .0001). Thirty-day postoperative mortality was similar between groups (1.4% vs 2.9%; P = not significant). By multivariable analysis, preoperative congestive heart failure, nonelective surgery, prolonged cardiopulmonary bypass times, peripheral vascular disease, and lower creatinine clearance were significant risk factors for postoperative mortality; however, prior kidney transplant was not an independent risk factor for 30-day postoperative mortality.

Conclusions: Despite their increased incidence of comorbid conditions, the postoperative outcomes of cardiac surgery in kidney transplant recipients are similar to those in the nontransplant population except for a higher incidence of kidney dysfunction in transplant patients.

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Discussion
J. Thorac. Cardiovasc. Surg. 2007 133: 1218-1219. [Extract] [Full Text] [PDF]