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Coronary bypass surgery after renal transplantation
1First Department of Surgery, Yamaguchi University School of Medicine, Ube, Japan.
The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|May 5, 1999
Summary
Coronary artery bypass grafting (CABG) is safe for renal transplant recipients. Careful perioperative management, including immunosuppression and maintaining perfusion pressure during cardiopulmonary bypass, ensures good outcomes and preserved renal function.
Area of Science:
- Cardiology
- Nephrology
- Transplantation
Background:
- Renal transplant recipients often have underlying cardiovascular disease requiring intervention.
- Coronary artery bypass grafting (CABG) in this population presents unique perioperative challenges.
- Management requires balancing immunosuppression and cardiopulmonary bypass considerations.
Purpose of the Study:
- To report on the perioperative management and outcomes of two renal transplant patients undergoing CABG.
- To discuss strategies for safe surgical intervention in this high-risk group.
Main Methods:
- Case report of two renal transplant patients (one early post-transplant, one chronic).
- Detailed description of perioperative immunosuppressive agent management (cyclosporin A, cyclophosphamide).
- Cardiopulmonary bypass management focused on maintaining perfusion pressure (approx. 80 mmHg) for optimal urine output; CD4/CD8 ratio monitoring.
Main Results:
- Both patients experienced a good clinical course with well-maintained postoperative renal function.
- Adequate urine output was achieved during cardiopulmonary bypass (300 ml and 650 ml).
- No significant changes in CD4/CD8 ratio indicating graft rejection were observed perioperatively.
Conclusions:
- Coronary artery bypass grafting can be safely performed in renal transplant recipients.
- Appropriate perioperative immunosuppressive drug management is crucial.
- Maintaining adequate perfusion pressure during cardiopulmonary bypass is essential for preserving renal function.