Pretransplant coronary artery disease associated with worse clinical outcomes in pancreas transplantation.
BACKGROUND
Coronary artery disease (CAD) is common in patients with type I diabetes and may be associated with worse outcomes in patients undergoing pancreas transplantation (PT). This study evaluates PT patients to determine the pre transplant prevalence of CAD and assesses the post-transplant outcomes including complications and survival.


METHODS
This study is a retrospective review of PTs from 2003 to 2011. Diagnosis of CAD required cardiac catheterization. Outcomes included: myocardial infarction (MI), stroke, and survival.


RESULTS
There were 405 transplants in 389 patients with median follow-up of 56 months. Pre transplant prevalence of CAD was 19% (n = 74). There was no increased risk of perioperative, 90-d or one-yr mortality for patients with CAD. The CAD group did have increased risk of MI (11% vs. 1%, p < 0.001) and stroke (8% vs. 3%, p = 0.02). Controlling for patient and donor age, and history of CAD, the CAD group had decreased patient survival at five yr (82% vs. 90%, p = 0.09, HR 1.77) by Cox regression.


CONCLUSIONS
Patients with type I diabetes and CAD have increased risk of MI and stroke post-pancreas transplant, with decreased five-yr survival. Patients without CAD and a negative pre transplant cardiac evaluation carry a low risk of post-transplant MI.
Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202-5250, USA. rmangus@iupui.edu
Richard S
RS
Mangus
John
J
Powelson
Sandra B
SB
Kinsella
Damond T
DT
Farar
Cristina A
CA
Creal
Jonathan A
JA
Fridell
D000328:Adult; D003324:Coronary Artery Disease / Q000150:complications* / Q000401:mortality; D048909:Diabetes Complications / Q000209:etiology / Q000401:mortality*; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality*; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000401:mortality*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
coronary artery disease; myocardial infarction; outcomes; pancreas transplantation; vascular disease