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Cardiac surgery after renal transplantation
V Seenu Reddy1, Ashton C Chen, H Keith Johnson
1Department of Cardiac and Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
The American Surgeon
|February 15, 2002
Summary
Cardiac surgery is relatively safe for renal transplant recipients, with low rates of dialysis and favorable long-term survival. These findings support continued cardiac procedures in patients with functioning renal allografts.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Surgery
Background:
- End-stage renal disease (ESRD) patients often have coexisting cardiac conditions.
- Renal transplantation is a primary treatment for ESRD.
- High prevalence of cardiac disease necessitates evaluating cardiac surgery safety in this population.
Purpose of the Study:
- To review factors and outcomes of cardiac surgery in renal transplant recipients.
- To assess the safety and efficacy of cardiac procedures in patients with functioning renal allografts.
Main Methods:
- Retrospective review of patients with functioning renal allografts undergoing cardiac surgery requiring cardiopulmonary bypass.
- Data collected on patient demographics, surgical procedures, perioperative events, and long-term outcomes.
- Analysis of factors predicting the need for perioperative dialysis.
Main Results:
- Zero operative mortality; two hospital deaths (multisystem organ failure, pulmonary embolism).
- Overall survival of 69% at a median follow-up of 38 months.
- Low incidence of perioperative (4/26) and late (2/26) dialysis requirement; preoperative creatinine, hematocrit, and intraoperative urine output predicted acute dialysis need.
Conclusions:
- Standard cardiac surgery can be performed with relative safety in renal transplant recipients.
- Low rates of renal failure and favorable long-term survival and symptomatic improvement justify these procedures.
- Cardiac surgery in patients with functioning renal allografts is warranted.