Related Experiment Videos
Coronary bypass surgery after renal transplantation
1First Department of Surgery, Yamaguchi University School of Medicine, Ube, Japan.
Insights
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.
Abstract:
We report, herein, cases of two renal transplantation patients who underwent coronary artery bypass grafting and discuss the perioperative management of this clinical situation. The first case was a 43-year-old male who underwent coronary artery bypass grafting 50 days after renal transplantation, and the second was a chronic case of a 49-year-old male who underwent coronary artery bypass grafting 17 years after renal transplantation. Prior to the operation, the first patient was continuously administered 2 mg/kg/day of cyclosporin A with the dosage regulated according to the plasma level. The second patient was administered 50 mg/day of cyclophosphamide intravenously instead of an oral dosage of 50 mg/day of azathioprine just prior to the operation. In both patients, perfusion pressure during cardiopulmonary bypass was maintained at approximately 80 mmHg in order to obtain optimal urine output. The CD4/CD8 ratio was monitored for indication of graft rejection, but no remarkable changes were observed perioperatively in either patient. Both patients followed a good clinical course and their postoperative renal function was well maintained. The urine output during cardiopulmonary bypass was 300 ml and 650 ml, respectively. The patients were discharged 15 and 27 days after their operation, respectively. In conclusion, coronary artery bypass grafting can be safely performed in patients who have undergone renal transplantation, if there is appropriate perioperative usage of immunosuppressive agents and maintenance of perfusion pressure during cardiopulmonary bypass.