Kidney-Pancreas Transplant Recipients Experience Higher Risk of Complications Compared to the General Population After Undergoing Coronary Artery Bypass Grafting

Overview

Journal Int J Angiol

Date 2021 May 31

PMID 34054268

Authors

Jordyn M Perdue

Alejandro C Ortiz

Afshin Parsikia

Jorge Ortiz

Affiliations

Soon will be listed here.

Abstract

This retrospective analysis aims to identify differences in surgical outcomes between pancreas and/or kidney transplant recipients compared with the general population undergoing coronary artery bypass grafting (CABG). Using Nationwide Inpatient Sample (NIS) data from 2005 to 2014, patients who underwent CABG were stratified by either no history of transplant, or history of pancreas and/or kidney transplant. Multivariate analysis was used to calculate odds ratio (OR) to evaluate in-hospital mortality, morbidity, length of stay (LOS), and total hospital charge in all centers. The analysis was performed for both nonemergency and emergency CABG. Overall, 2,678 KTx (kidney transplant alone), 184 PTx (pancreas transplant alone), 254 KPTx (kidney-pancreas transplant recipients), and 1,796,186 Non-Tx (nontransplant) met inclusion criteria. KPTx experienced higher complication rates compared with Non-Tx (78.3 vs. 47.8%, < 0.01). Those with PTx incurred greater total hospital charge and LOS. On weighted multivariate analysis, KPTx was associated with an increased risk for developing any complication following CABG (OR 3.512, < 0.01) and emergency CABG (3.707, < 0.01). This risk was even higher at transplant centers (CABG OR 4.302, < 0.01; emergency CABG OR 10.072, < 0.001). KTx was associated with increased in-hospital mortality following emergency CABG, while PTx and KPTx had no mortality to analyze. KPTx experienced a significantly higher risk of complications compared with the general population after undergoing CABG, in both transplant and nontransplant centers. These outcomes should be considered when providing perioperative care.

References

De Giorgi A, Fabbian F . Identifying Increased Risk of Readmission and In-hospital Mortality Using Hospital Administrative Data. Med Care. 2017; 55(10):905. DOI: 10.1097/MLR.0000000000000793. View

Reddy K, Stablein D, Taranto S, Stratta R, Johnston T, Waid T . Long-term survival following simultaneous kidney-pancreas transplantation versus kidney transplantation alone in patients with type 1 diabetes mellitus and renal failure. Am J Kidney Dis. 2003; 41(2):464-70. DOI: 10.1053/ajkd.2003.50057. View

Davierwala P, Mohr F . Bilateral internal mammary artery grafting: rationale and evidence. Int J Surg. 2015; 16(Pt B):133-9. DOI: 10.1016/j.ijsu.2015.01.012. View

Sharma R, Hawley C, Griffin R, Mundy J, Peters P, Shah P . Cardiac surgical outcomes in abdominal solid organ (renal and hepatic) transplant recipients: a case-matched study. Interact Cardiovasc Thorac Surg. 2012; 16(2):103-11. PMC: 3548526. DOI: 10.1093/icvts/ivs442. View

Kubal C, Srinivasan A, Grayson A, Fabri B, Chalmers J . Effect of risk-adjusted diabetes on mortality and morbidity after coronary artery bypass surgery. Ann Thorac Surg. 2005; 79(5):1570-6. DOI: 10.1016/j.athoracsur.2004.10.035. View

Aldea G, Bakaeen F, Pal J, Fremes S, Head S, Sabik J . The Society of Thoracic Surgeons Clinical Practice Guidelines on Arterial Conduits for Coronary Artery Bypass Grafting. Ann Thorac Surg. 2015; 101(2):801-9. DOI: 10.1016/j.athoracsur.2015.09.100. View

Larsen J, Larson C, Hirst K, Miller S, Ozaki C, Taylor R . Lipid status after combined pancreas-kidney transplantation and kidney transplantation alone in type I diabetes mellitus. Transplantation. 1992; 54(6):992-6. DOI: 10.1097/00007890-199212000-00010. View

Reddy V, Chen A, Johnson H, Pierson 3rd R, Christian K, Drinkwater Jr D . Cardiac surgery after renal transplantation. Am Surg. 2002; 68(2):154-8. View

Woods S, Smith J, Sohail S, Sarah A, Engle A . The influence of type 2 diabetes mellitus in patients undergoing coronary artery bypass graft surgery: an 8-year prospective cohort study. Chest. 2004; 126(6):1789-95. DOI: 10.1378/chest.126.6.1789. View

10.

DeVries J, Collier R, Niezgoda J, Sanicola S, Simanonok J . Impaired lower extremity wound healing secondary to sirolimus after kidney transplantation. J Am Col Certif Wound Spec. 2014; 1(3):86-91. PMC: 3478904. DOI: 10.1016/j.jcws.2009.06.001. View

11.

Ono M, Wolf R, Angouras D, Brown D, Goldstein A, Michler R . Short- and long-term results of open heart surgery in patients with abdominal solid organ transplant. Eur J Cardiothorac Surg. 2002; 21(6):1061-72. DOI: 10.1016/s1010-7940(02)00060-x. View

12.

Sahni S, Molmenti E, Bhaskaran M, Ali N, Basu A, Talwar A . Presurgical pulmonary evaluation in renal transplant patients. N Am J Med Sci. 2015; 6(12):605-12. PMC: 4290048. DOI: 10.4103/1947-2714.147974. View

13.

Halkos M, Puskas J, Lattouf O, Kilgo P, Kerendi F, Song H . Elevated preoperative hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2008; 136(3):631-40. DOI: 10.1016/j.jtcvs.2008.02.091. View

14.

Kohmoto T, Osaki S, Kaufman D, Leverson G, DeOliveira N, Akhter S . Cardiac Surgery Outcomes in Abdominal Solid Organ Transplant Recipients. Ann Thorac Surg. 2017; 105(3):757-762. DOI: 10.1016/j.athoracsur.2017.09.002. View

15.

Carson J, Scholz P, Chen A, Peterson E, Gold J, Schneider S . Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol. 2002; 40(3):418-23. DOI: 10.1016/s0735-1097(02)01969-1. View

16.

Vargo P, Schiltz N, Johnston D, Smedira N, Moazami N, Blackstone E . Outcomes of Cardiac Surgery in Patients With Previous Solid Organ Transplantation (Kidney, Liver, and Pancreas). Am J Cardiol. 2015; 116(12):1932-8. DOI: 10.1016/j.amjcard.2015.09.036. View

17.

Chowdhury T . Post-transplant diabetes mellitus. Clin Med (Lond). 2019; 19(5):392-395. PMC: 6771354. DOI: 10.7861/clinmed.2019-0195. View

18.

Samadashvili Z, Sundt 3rd T, Wechsler A, Chikwe J, Adams D, Smith C . Multiple Versus Single Arterial Coronary Bypass Graft Surgery for Multivessel Disease. J Am Coll Cardiol. 2019; 74(10):1275-1285. DOI: 10.1016/j.jacc.2019.06.067. View

19.

DiBrito S, Bowring M, Holscher C, Haugen C, Rasmussen S, Duncan M . Acute Care Surgery for Transplant Recipients: A National Survey of Surgeon Perspectives and Practices. J Surg Res. 2019; 243:114-122. PMC: 6773475. DOI: 10.1016/j.jss.2019.05.008. View

20.

Aref A, Zayan T, Pararajasingam R, Sharma A, Halawa A . Pancreatic transplantation: Brief review of the current evidence. World J Transplant. 2019; 9(4):81-93. PMC: 6715578. DOI: 10.5500/wjt.v9.i4.81. View