Cardiovascular surgery after renal transplantation--indications, complications and outcome

Cardiovascular diseases are the major cause of morbidity and mortality in renal transplant recipients. We report our experience in the treatment of patients with renal allograft who required cardiovascular surgery.

Indications for cardiovascular surgery, postoperative complications, and outcome were recorded in a cohort of renal transplant recipients.

Thirteen patients, five female and eight male, aged from 46 to 75 years underwent cardiac surgery after renal transplantation at University Hospital Centre Zagreb. Isolated coronary artery bypass grafting (CABG) was performed in five patients, valve replacement in six patients, reconstruction of ascending aorta, and aortic arch in one patient as well as the extraction of tumor formation from the heart. Three patients had simultaneous CABG and valve replacement. Four patients (31%) required acute hemodialysis after the surgery and two of them continued with dialysis after discharge. Postoperative course was complicated with infections of the lower respiratory tract in two patients, pericardial tamponade, unstable sternum with bleeding from the wound, increased drainage from the chest demanding additional hemostasis, and in-stent restenosis in the previously placed stents, in one patient each. Fatal outcome occurred in two patients who underwent simultaneous valvular replacement and CABG within one month from the surgery.

In patients with functional renal allograft cardiovascular, surgery procedures are safe, but associated with increased incidence of perioperative complications, with majority of patients maintaining their graft function.