title: Perioperative outcomes of cardiac surgery in kidney and kidney-pancreas transplant recipients.
abstract: OBJECTIVE
  Cardiovascular disease is a common cause of morbidity and mortality in organ transplant recipients, and cardiac surgery has become more common in this population. We performed a retrospective study of kidney transplant recipients who underwent cardiac surgery over the past 10 years at our institution with an emphasis on evaluating postoperative outcomes.
  
  
  METHODS
  Seventy-four patients with previous abdominal transplants underwent cardiac surgery (93% coronary artery bypass grafting, 5.4% bypass grafting plus valve, and 1.4% valve) between 1995 and 2005. These recipients were compared with 895 adult nontransplant patients undergoing cardiac surgery between 2000 and 2005. Only kidney and kidney-pancreas recipients were included in the analysis (n = 70) because there were only 2 liver and pancreas alone transplants.
  
  
  RESULTS
  As compared with nontransplant patients, kidney transplant patients were younger (mean age 52.1 +/- 10 years vs 61 +/- 13 years; P < .001) and had an increased incidence of diabetes (92.9% vs 39.1%; P < .001), peripheral vascular disease (37.1% vs 19.1%; P < .001), chronic kidney insufficiency (73.0% vs 13.4%; P < 0.001), and unstable angina (44.8% vs 25.7%; P = .005) There was no difference between the two groups in the complication rate at 30 days after surgery, except that transplant patients were more likely to have postoperative kidney dysfunction (32.6% vs 6.1%; P < .001) and require hemodialysis (11.7% vs 1.1%; P < .0001). Thirty-day postoperative mortality was similar between groups (1.4% vs 2.9%; P = not significant). By multivariable analysis, preoperative congestive heart failure, nonelective surgery, prolonged cardiopulmonary bypass times, peripheral vascular disease, and lower creatinine clearance were significant risk factors for postoperative mortality; however, prior kidney transplant was not an independent risk factor for 30-day postoperative mortality.
  
  
  CONCLUSIONS
  Despite their increased incidence of comorbid conditions, the postoperative outcomes of cardiac surgery in kidney transplant recipients are similar to those in the nontransplant population except for a higher incidence of kidney dysfunction in transplant patients.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn 55455, USA. johnx008@umn.edu
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.forename: Katherine
authors.initials: K
authors.lastname: Lietz
authors.forename: Stephen
authors.initials: S
authors.lastname: Huddleston
authors.forename: Arthur
authors.initials: A
authors.lastname: Matas
authors.forename: Kenneth
authors.initials: K
authors.lastname: Liao
authors.forename: Sara
authors.initials: S
authors.lastname: Shumway
authors.forename: Lyle
authors.initials: L
authors.lastname: Joyce
authors.forename: R Morton
authors.initials: RM
authors.lastname: Bolman
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D011182:Postoperative Care; D011183:Postoperative Complications; D011300:Preoperative Care; D006435:Renal Dialysis; D012086:Reoperation; D012307:Risk Factors; D013318:Stroke Volume; D016896:Treatment Outcome
chemical_list: D003404:Creatinine