Cardiac Surgery in Patients With Previous Hepatic or Renal Transplantation: A Pair-Matched Study

The objective of this study was to compare outcomes of patients with previous solid organ transplant with those of a pair-matched population.

Data from our prospectively maintained cardiac surgery registry were obtained and identified 70 transplant recipients (21 hepatic, 49 renal) who were operated on at our department of cardiac surgery between 2000 and 2013; they formed the transplant group. Those patients were pair-matched regarding age, sex, and cardinal cardiac risk factors to form the pair-matched group.

Early mortality was 15.7% in the transplant group (23.8% hepatic, 12.2% renal allograft recipients) versus 5.7% in the pair-matched population. The overall mortality was 32.9% in the transplant group (38.1% hepatic, 30.6% renal allograft recipients) versus 11.4% in the pair-matched group (p < 0.01) over a median follow-up of 32 months. Transplant patients had more bleeding complications (12.9%) than the pair-matched patients (1.4%), and more operative reexploration (15.7% versus 2.9%), atrial fibrillation (32.9% versus 10.0%), new-onset dialysis (17.1% versus 5.7%), and sepsis (10.0% versus 1.4%). One-, 2-, 5-, and 10-year survival for the transplant group versus the pair-matched group, respectively, was 74%, 71%, 66%, and 56% versus 93%, 91%, 88%, 81%. Multivariate predictors of mortality were solid organ transplant (hazard ratio 3.8, 95% confidence interval: 1.6 to 9.2), intraoperative transfusion (hazard ratio 1, 95% confidence interval: 1.00 to 1.01), and postoperative increase in bilirubin concentration (hazard ratio 1.34, 95% confidence interval: 1.08 to 1.65).

Cardiac surgery is feasible for recipients of solid organ transplants with acceptable early morbidity and mortality.