Cardiac surgery in kidney and liver transplant recipients

To evaluate operative management, outcome, and long-term survival in patients with functioning renal and hepatic allografts who underwent cardiac surgery.

We studied all patients who had previously undergone either renal or hepatic transplantation and who subsequently (1986-2001) underwent cardiac surgery at our institution. Data were obtained by retrospective medical record analysis.

The study comprised 47 patients with renal (n=34) and hepatic (n=13) functioning allografts. Median time to cardiac surgery from transplantation was 79 months. The most common procedures were as follows: coronary artery bypass grafting, 22 (47%); aortic valve procedures, 11 (23%); and mitral valve procedures, 5 (11%). One patient (2%) died within 30 days of surgery. Renal allograft dysfunction was noted in 5 renal patients (15%) immediately after surgery. Two patients required dialysis postoperatively, 1 of whom required continued dialysis on dismissal. Transient allograft dysfunction, as determined by elevated liver enzyme levels, occurred in 6 hepatic patients (46%). However, all hepatic patients had functional allografts on dismissal. Two patients (4%) developed leg wound infections, and 9 (19%) had respiratory complications. No sternal or mediastinal infection occurred. One- and 5-year survival rates (mean +/- SEM) for all patients were 93%+/-4% and 76%+/-8%, respectively. Of the renal patients, 1- and 5-year survival rates (mean +/- SEM) were 97%+/-3% and 82%+/-8%, respectively. One- and 5-year survival rates (mean +/- SEM) for hepatic patients were 77%+/-12% and 69%+/-13%, respectively.

Cardiac surgery can be performed safely in kidney and liver transplant recipients, with low early mortality and excellent medium-term survival. In almost all instances, allograft function is well preserved.