|
|
Outcomes of Cardiac Surgery in Abdominal Solid Organ Transplant Recipients
R. John1, S. Huddleston1, K. Lietz1, K. Liao1, S. Shumway1, L. Joyce1, M. Bolman2. 1University of Minnesota, Minneapolis, MN, 2Harvard University, Boston, MA,
Background: Cardiovascular disease is a common cause of morbidity and mortality in organ transplant recipients. With an increasing number of abdominal organ transplant recipients, cardiac surgery has become more common in this population.
Methods: We retrospectively evaluated 75 transplant recipients (58 kidney, 7 kidney-pancreas, 7 pancreas and 2 liver) who underwent cardiac surgery (93% CABG, 5.4% CABG + valve and 1.4% valve) between 1995 and 2005.
Results: Patients with prior abdominal transplants were younger (mean age 50 ± 10 yrs vs. 61 ±13 yrs, p<0.001), with increased incidence of diabetes (91.9% v. 39.1%, p<0.001), peripheral vascular disease (PVD) (39.2% v. 19.1%, p<0.001), chronic renal insufficiency (73.0% v. 13.4%, p<0.001) and unstable angina (44.8% v. 25.7%, p=0.005) as compared to non-transplant patients. There was no difference in the overall complication rate at 30-days after surgery between the two groups, except that transplant patients were more likely to have renal dysfunction (25.7% v. 6.1%, P<0.001) and require hemodialysis (11.7% v. 1.1%, P<0.0001). 30-day mortality was similar between groups (1.4% vs. 2.9%, p=NS). By multivariable analysis, heart failure, non-elective surgery, prolonged cardiopulmonary bypass, PVD, and lower creatinine clearance were significant risk factors for mortality; however, prior abdominal organ transplant was not an independent risk factor for postoperative mortality.
Conclusions: Despite an increased incidence of comorbid conditions, the postoperative outcomes of cardiac surgery in abdominal solid organ transplant recipients are similar to that in the non-transplant population. Factors contributing to this may include perioperative strict glycemic control, modification of immunosuppression and meticulous antibiotic prophylaxis.
Back to 32nd Annual Meeting
Back to Program Outline
|
