title: Midterm outcomes of off-pump and on-pump coronary artery revascularization in renal transplant recipients.
abstract: OBJECTIVE
  Renal transplant recipients have high mortality from cardiac causes and are frequently in need of coronary interventions. Surgical coronary revascularization is associated with significant morbidity and mortality in this patient population. This study was undertaken to evaluate outcomes of on-pump versus off-pump revascularization in renal transplant recipients.
  
  
  METHODS
  We retrospectively reviewed 43 renal transplant recipients who underwent surgical coronary revascularization with functioning allografts. Revascularization was performed on-pump [coronary artery bypass grafting (CABG)] in 21 patients and off-pump [off-pump coronary artery bypass (OPCAB)] in 22 patients.
  
  
  RESULTS
  Preoperative characteristics did not differ between the two groups except for age and incidence of prior sternotomy. Total operative time and transfusion requirements were similar. The on-pump group received a higher number of bypass grafts (p = 0.03). Overall 30-day, one-year, five-year, and eight-year survival was 90%, 76%, 61%, and 32% for CABG group, and 95%, 86%, 62%, and 48% for OPCAB group (p = 0.53). The postoperative peak creatinine was higher in the CABG patients than in OPCAB patients (p = 0.04). At discharge, there was no difference in mean creatinine between the two groups. The rate of return to permanent dialysis after revascularization was similar (28% for CABG and 22% for OPCAB, p = 0.73). There was no difference in dialysis-free survival up to eight-years postrevascularization (p = 0.63).
  
  
  CONCLUSIONS
  Despite higher mortality risk, surgical coronary revascularization can be performed safely in renal transplant recipients. OPCAB resulted in no improvement in patient survival or renal allograft function compared to on-pump revascularization.
authors: Department of Cardiothoracic Surgery, Thomas E. Starzl Transplantation Institute, and Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors: Hossein
authors: H
authors: Shayan
authors: Rodolfo
authors: R
authors: Rocha
authors: Lawrence
authors: L
authors: Wei
authors: Thomas
authors: T
authors: Gleason
authors: Diana
authors: D
authors: Zaldonis
authors: Ronald
authors: R
authors: Pellegrini
authors: Yoshiya
authors: Y
authors: Toyoda
authors: Ron
authors: R
authors: Shapiro
authors: Ferhaan
authors: F
authors: Ahmad
authors: Christian
authors: C
authors: Bermudez
mesh_terms: D002423:Cause of Death / Q000639:trends; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome