title: Cardiac surgical outcomes in abdominal solid organ (renal and hepatic) transplant recipients: a case-matched study.
abstract: OBJECTIVE
  This study aims to investigate the outcomes of cardiac surgery in patients with abdominal solid organ transplants and to compare them with the case-matched population undergoing cardiac surgery.
  
  
  METHODS
  Data from all transplant recipients abdominal solid organ transplant (ASOT) N = 36 (30 renal and 6 hepatic) who underwent cardiac surgery in a single centre during the period from January 1997 to December 2010 were collected from hospital transplant registries and the cardiac database. The transplant recipients were case matched (CM) with 104 patients in terms of the variables of age, sex and the type of cardiac surgery. Follow-up data were obtained from medical records and by a set of questionnaire through telephonic interviews.
  
  
  RESULTS
  Follow-up times were 4.5 ± 3.2 and 3.9 ± 3.2 years in the transplant and CM groups, respectively. Follow-up in the transplant group was 100%. There was no 30-day mortality in the transplant group. Thirty-day combined major morbidities were 9% in the matched group vs 11% in the transplant patients (P = 0.6). Median length of stay was 6 days (inter-quartile range, IQR 5.9) for ASOT vs 5 days (IQR 4.6) for CM (P < 0.01). New dialysis was 8.3% in transplant patients compared with 0.96% in the matched population, while infection was 16.66 vs 0.42% in the CM cohort. There was no allograft failure/dysfunction at the time of death or latest follow-up. Late deaths were 8 of 36 (22%) in ASOT vs 6 of 104 (6%) in CM. Infection (63%) was the most frequent major cause of death in transplant patients. One-, 2-, 5- and 10-year survivals for ASOT vs CM were 94, 88, 80, 59 vs 99, 99, 91, 85%, respectively. Multivariate predictors of mortality were increasing age (hazard ratio, HR 1.1, 95% confidence interval, CI 1.04-1.18; P = 0.003) and solid organ transplantation (HR 3.44, CI 1.19-9.98; P = 0.023).
  
  
  CONCLUSIONS
  Cardiac surgery can be performed in patients with abdominal solid organ tranpslant recipients with acceptable early morbidity and mortality. However, long-term survival in transplant patients is poor. Infection remains the most common cause of death.
authors.affiliation: Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Brisbane, Australia. docrajivsharma@gmail.com
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sharma
authors.forename: Carmel
authors.initials: C
authors.lastname: Hawley
authors.forename: Raylene
authors.initials: R
authors.lastname: Griffin
authors.forename: Julie
authors.initials: J
authors.lastname: Mundy
authors.forename: Paul
authors.initials: P
authors.lastname: Peters
authors.forename: Pallav
authors.initials: P
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016022:Case-Control Studies; D002423:Cause of Death; D016009:Chi-Square Distribution; D003141:Communicable Diseases / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome