title: Outcomes of Cardiac Surgery in Patients With Previous Solid Organ Transplantation (Kidney, Liver, and Pancreas).
abstract: A growing number of solid organ transplant survivors require surgery for cardiac disease. We examined the effect of having a previous transplant on outcomes after cardiac surgery in these patients from a population-based perspective. Of 1,709,735 patients who underwent coronary artery bypass grafting, valve, or thoracic aorta surgery from 2004 to 2008 in the Nationwide Inpatient Sample, 3,535 patients (0.21%) had a previous organ transplant (2,712 kidney, 738 liver, 300 pancreas). Multivariate logistic regression analysis and propensity score matching were used to determine the effect of a previous solid organ transplant on outcomes. In-hospital mortality rate was 7% for patients who underwent transplantation versus 4% for patients who did not undergo transplantation (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.16 to 2.38). Patients who underwent transplantation were at an increased risk for acute renal failure (OR 1.62, CI 1.36 to 1.94) and blood transfusions (OR 1.63, CI 1.36 to 1.95). Median length of stay was longer (10 vs 9 days), with greater median total charges ($111,362 vs $102,221; both p <0.001). Occurrence of stroke, gastrointestinal complication, infection, and pneumonia was similar between groups. In conclusion, previous solid organ transplantation is an incremental risk factor for postoperative mortality after cardiac surgery. Renal protective strategies and bleeding control should be stressed to mitigate complications.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Heart and Vascular Institute, Cleveland, Ohio. Electronic address: pr.vargo@gmail.com.
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Vargo
authors.affiliation: Department of Epidemiology and Biostatistics, Population Health and Outcomes Research Core, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Nicholas K
authors.initials: NK
authors.lastname: Schiltz
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Johnston
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Heart and Vascular Institute, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure, Cleveland Clinic, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Smedira
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Heart and Vascular Institute, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure, Cleveland Clinic, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Nader
authors.initials: N
authors.lastname: Moazami
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Heart and Vascular Institute, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Research Institute, Cleveland, Ohio.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Heart and Vascular Institute, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Kaufman Center for Heart Failure, Cleveland Clinic, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Edward G
authors.initials: EG
authors.lastname: Soltesz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016035:Pancreas Transplantation; D011183:Postoperative Complications / Q000453:epidemiology*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult