title: The significance of pre-operative coronary interventions on outcome after pancreas transplantation.
abstract: Pancreas transplant candidates are at very high risk of coronary vascular disease. We hypothesized that the requirement for pre-operative coronary intervention (PCI) may be associated with an adverse impact on short- and long-term outcomes. Retrospective analysis of 366 consecutive primary pancreas transplants was undertaken. Outcomes were compared between recipients who had undergone PCI (n = 48) and those who had not (n = 318). In 48% (23/48) of instances, the PCI was initiated by the transplant cardiology evaluation. The recipients undergoing PCI were older than those not undergoing PCI (47.6 yr vs. 41.9 yr, respectively, p < 0.0001). Although not statistically significant, there was a higher rate of post-operative major cardiovascular events (MCVE) in the PCI group (10.4%) compared with those not undergoing PCI (4.7%) (RR [95% CI]: 2.0 [0.90-4.5]; p = 0.17). In the long term, there were no differences in the rate of death with graft function (p = 0.77) or rejection (p = 0.17). There were no statistically significant differences between the groups with respect to patient (p = 0.54), kidney (p = 0.76), or pancreas (p = 0.63) graft survival. PCI is not a risk factor for short-term perioperative events, and long-term transplant outcomes are equivalent to patients not requiring PCI. PCI, by itself, should not be considered a contraindication for pancreas transplantation, but should raise awareness of perioperative risk.
authors.affiliation: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.|RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, NSW, Australia.
authors.forename: Jerome M
authors.initials: JM
authors.lastname: Laurence
authors.affiliation: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Barbas
authors.affiliation: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Sapisochin
authors.affiliation: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Max A
authors.initials: MA
authors.lastname: Marquez
authors.affiliation: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Fateh
authors.initials: F
authors.lastname: Bazerbachi
authors.affiliation: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Markus
authors.initials: M
authors.lastname: Selzner
authors.affiliation: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Norgate
authors.affiliation: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Ian D
authors.initials: ID
authors.lastname: McGilvray
authors.affiliation: Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Schiff
authors.affiliation: RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, NSW, Australia.
authors.forename: Heather
authors.initials: H
authors.lastname: Ross
authors.affiliation: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Cattral
mesh_terms: D000328:Adult; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D008297:Male; D016035:Pancreas Transplantation / Q000009:adverse effects*; D010182:Pancreatic Diseases / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: coronary intervention; graft survival; insulin-dependent diabetes mellitus; outcomes; pancreas transplantation