Cardiac Surgical Outcomes in Abdominal Solid Organ (Renal and Hepatic) Transplant Recipients: A Case Matched Study

Abstract

OBJECTIVES: This study aims to investigate the outcomes of cardiac surgery in patients with abdominal solid organ transplants and to compare them with the case-matched population undergoing cardiac surgery. METHODS:Data from all transplant recipients abdominal solid organ transplant (ASOT) N = 36 (30 renal and 6 hepatic) who underwent cardiac surgery in a single centre during the period from January 1997 to December 2010 were collected from hospital transplant registries and the cardiac database. The transplant recipients were case matched (CM) with 104 patients in terms of the variables of age, sex and the type of cardiac surgery. Follow-up data were obtained from medical records and by a set of questionnaire through telephonic interviews.RESULTS: Follow-up times were 4.5 ± 3.2 and 3.9 ± 3.2 years in the transplant and CM groups, respectively. Follow-up in the transplant group was 100%. There was no 30-day mortality in the transplant group. Thirty-day combined major morbidities were 9% in the matched group vs 11% in the transplant patients (P = 0.6). Median length of stay was 6 days (inter-quartile range, IQR 5.9) for ASOT vs 5 days (IQR 4.6) for CM (P < 0.01). New dialysis was 8.3% in transplant patients compared with 0.96% in the matched population, while infection was 16.66 vs 0.42% in the CM cohort. There was no allograft failure/dysfunction at the time of death or latest follow-up. Late deaths were 8 of 36 (22%) in ASOT vs 6 of 104 (6%) in CM. Infection (63%) was the most frequent major cause of death in transplant patients. One-, 2-, 5-and 10-year survivals for ASOT vs CM were 94, 88, 80, 59 vs 99, 99, 91, 85%, respectively. Multivariate predictors of mortality were increasing age (hazard ratio, HR 1.1, 95% confidence interval, CI 1.04-1.18; P = 0.003) and solid organ transplantation (HR 3.44, CI 1.19-9.98; P = 0.023).CONCLUSIONS: Cardiac surgery can be performed in patients with abdominal solid organ tranpslant recipients with acceptable early morbidity and mortality. However, long-term survival in transplant patients is poor. Infection remains the most common cause of death.

Cardiac Surgery Outcomes in Abdominal Solid Organ Transplant Recipients

“…That may suggest that the STS mortality risk score is more accurate in predicting transplant patient mortality after heart surgery. Although others have reported no early mortality for liver transplant patients, we found no early mortality for the kidneypancreas transplant patients [26].…”

“…It is worth noting that our data demonstrate 15-year survival, whereas most studies show 1-to 5-year long-term survival [12,15]. Sharma and colleagues [26] found a 59% survival rate for transplanted patients 10 years after cardiac surgery. Their rate is still higher than the survival rate of our transplanted patients 10 years after cardiac surgery.…”

Postoperative outcomes of kidney transplant recipients undergoing non-transplant-related elective surgery: a systematic review and meta-analysis

“…Fourteen studies, involving 15,481 solid organ transplant recipients of whom 14,427 (95%) were kidney transplants, and 7,807,705 non-transplanted patients satisfied the inclusion criteria (Table 1: Summary of included studies). Non-emergent cardiac (5 studies) [5,18,20,24,27] and orthopaedic (5 studies) [16,17,19,22,23] surgery were the most commonly reported types of surgery. General surgical outcomes were reported in 3 studies [4,21,25].…”

“…A single study assessed outcomes following urological/gynaecological procedures [26] and there were no studies in vascular surgery. Six studies assessed a single surgical procedure [16,17,19,22,23,26], while the remainder examined a combination of discipline-specific surgical interventions [4,5,18,20,21,24,25,27]. All but 4 studies [18,21,22,24] were from North America.…”

Acceptable short-term outcomes after open heart surgery in kidney transplant recipients: a case control study

“…The number of KTR undergoing open heart surgery is steadily rising, as KTR live longer and have multiple risk factors for coronary heart and valve disease, including CKD, dialysis, posttransplant diabetes, arterial stiffness and immunosuppression (5). Even though surgical revascularization confers a high short-term risk, it is associated with favorable long-term outcome in the CKD population and probably also in KTR (6)(7)(8)(9)(10)(11). Since the first report on coronary artery bypass grafting in KTR in 1974 (12), numerous studies have been published (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24).…”