Excellent Results of Cardiac Surgery in Patients With Previous Kidney Transplantation

Objectives

Patients with a kidney allograft are at high risk for the development of cardiovascular diseases that may require surgical intervention. Little is known about the outcome of cardiac surgery in these patients.

Design

A retrospective study.

Setting

A university hospital (single institution).

Participants

Twenty-nine patients with a kidney allograft who underwent cardiac surgery between January 1998 and December 2006.

Interventions

None.

Measurements and Main Results

Main outcome measures were hospital mortality, postoperative complications, allograft function, and late survival. Twenty-nine patients (mean age, 53 ± 14 years; 18 (62%) male; 22 preserved allograft function, 2 acute failure, and 5 chronic failure) were identified. Hospital mortality was 3.4% (n = 1). Temporary allograft dysfunction determined by a >30% increase of creatinine and blood urea nitrogen was noticed in 5 (23%) patients with preserved allograft and recovered before discharge. Two patients required postoperative dialysis (1 temporary and 1 permanent). Six (21%) other major complications occurred and included respiratory failure (n = 4, 14%) and sepsis (n = 2, 7%). One- and 5-year survival was 89% ± 6% and 50% ± 14%, respectively. Four of 9 patients who died during follow-up had chronic allograft failure.

Conclusions

Cardiac surgery can be performed safely in kidney transplant recipients with low mortality and acceptable morbidities. Allograft dysfunction is a common finding, but it is transient with early functional recovery. Late survival of kidney recipients with chronic allograft failure undergoing cardiac procedures is limited when compared with that of the general cardiac surgery population. The present data suggest that these patients should be considered for cardiac surgery in reference centers with expertise in complex cardiac procedures and perioperative management of these highly specific patients.

Key Words: cardiac surgery, complications, kidney transplantation, long-term survival, mortality