Open Heart Operations After Renal Transplantation

Dresler, Christoph; Uthoff, K; Wahlers, T; Kliem, Volker; Schäfers, Jochen; Oldhafer, Karl J.; Borst, H. G.

doi:10.1016/s0003-4975(96)00768-0

Cited by 53 publications

(31 citation statements)

References 24 publications

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“…In our series, there was no perioperative mortality in either of the groups. This is in contrast to other studies where the perioperative mortality varied from 1.4 [2], 2 [23], 3 [16], 5 [15] and 8.8 [21] to 14% [1]. However, Prabhakar's group [14] has also reported no early mortality.…”

Section: Original Articlecontrasting

confidence: 80%

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Cardiac Surgical Outcomes in Abdominal Solid Organ (Renal and Hepatic) Transplant Recipients: A Case Matched Study

Sharma

Hawley

Griffin

et al. 2011

Heart, Lung and Circulation

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OBJECTIVES: This study aims to investigate the outcomes of cardiac surgery in patients with abdominal solid organ transplants and to compare them with the case-matched population undergoing cardiac surgery. METHODS:Data from all transplant recipients abdominal solid organ transplant (ASOT) N = 36 (30 renal and 6 hepatic) who underwent cardiac surgery in a single centre during the period from January 1997 to December 2010 were collected from hospital transplant registries and the cardiac database. The transplant recipients were case matched (CM) with 104 patients in terms of the variables of age, sex and the type of cardiac surgery. Follow-up data were obtained from medical records and by a set of questionnaire through telephonic interviews.RESULTS: Follow-up times were 4.5 ± 3.2 and 3.9 ± 3.2 years in the transplant and CM groups, respectively. Follow-up in the transplant group was 100%. There was no 30-day mortality in the transplant group. Thirty-day combined major morbidities were 9% in the matched group vs 11% in the transplant patients (P = 0.6). Median length of stay was 6 days (inter-quartile range, IQR 5.9) for ASOT vs 5 days (IQR 4.6) for CM (P < 0.01). New dialysis was 8.3% in transplant patients compared with 0.96% in the matched population, while infection was 16.66 vs 0.42% in the CM cohort. There was no allograft failure/dysfunction at the time of death or latest follow-up. Late deaths were 8 of 36 (22%) in ASOT vs 6 of 104 (6%) in CM. Infection (63%) was the most frequent major cause of death in transplant patients. One-, 2-, 5-and 10-year survivals for ASOT vs CM were 94, 88, 80, 59 vs 99, 99, 91, 85%, respectively. Multivariate predictors of mortality were increasing age (hazard ratio, HR 1.1, 95% confidence interval, CI 1.04-1.18; P = 0.003) and solid organ transplantation (HR 3.44, CI 1.19-9.98; P = 0.023).CONCLUSIONS: Cardiac surgery can be performed in patients with abdominal solid organ tranpslant recipients with acceptable early morbidity and mortality. However, long-term survival in transplant patients is poor. Infection remains the most common cause of death.

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Section: Original Articlecontrasting

confidence: 80%

“…Some of the groups have restricted the study to only valves [17] or only CABG [18,19]. However, most groups have studied the combined population of CABG and valve patients [13][14][15][16][20][21][22][23]. In our series, there was no perioperative mortality in either of the groups.…”

Section: Original Articlementioning

confidence: 90%

Cardiac Surgical Outcomes in Abdominal Solid Organ (Renal and Hepatic) Transplant Recipients: A Case Matched Study

Sharma

Hawley

Griffin

et al. 2011

Heart, Lung and Circulation

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“…[3][4][5] Only 3 reports, however, have been published in Japan. [6][7][8] All these patients were in the chronic phase and underwent open heart surgery 3 to 9 years after renal transplantation.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Bypass Grafting in the Acute Phase After Renal Transplantation

et al. 1999

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erioperative management is thought to be crucial in performing open-heart surgery on patients who have undergone renal transplantation. These patients are administered immunosuppressants, and are susceptible to infection or rejection. Moreover, the use of cardiopulmonary bypass (CPB) in open heart surgery causes renal function and levels of immunosuppressants to become unstable. Thus, the perioperative management of patients with a transplanted kidney during coronary artery bypass grafting (CABG) is very important. We report herein a case of patient who underwent CABG in the acute phase after renal transplantation. Particular attention is focused on the method used for administering immunosuppressants to this patient perioperatively. CaseThe patient was a 43-year-old man weighing 53.5 kg, who suffered angina pectoris and myocardial infarction in the posterior descending area after undergoing renal transplantation with a graft from his mother on June 4, 1996. He had undergone hemodialysis since the age of 41 year old. Emergency coronary angiography revealed 75% stenosis in the posterior descending artery (4PD), 75% stenosis in the midportion of the left anterior descending artery (mid-LAD), and 75% stenosis in the posterolateral branch (PL). Thus, 50 days after the renal transplantation, CABG of the 4PD, mid-LAD, and PL was performed under CPB. The Japanese Circulation Journal Vol.63, April 1999 CPB time was 206 min, and aortic cross-clamp time was 152 min. The single clamp method was used due to calcification of the ascending aorta. During CPB 440 ml of blood was transfused, and 640 ml of blood after CPB. We applied 1500 rad of irradiation to all blood in order to prevent graft versus host disease (GVHD). Preoperatively oral cyclosporin A (Cy-A), mizoribine, and methylprednisolone had been administered at 250 mg/day, 175 mg/day, and 20 mg/day, respectively. The trough level of Cy-A had been maintained at 100-300 ng/ml. The day before surgery, the oral Cy-A was changed over to a continuous intravenous infusion of 2.0 mg kg -1 day -1 , or one third the oral dosage. The oral methylprednisolone was also changed to intravenously administered hydrocortisone Na at 200 mg/day. Mizoribine was discontinued. The blood concentration of Cy-A was 388.2 ng/ml just before CPB, 204.7 ng/ml during Jpn Circ J 1999; 63: 309 -311 (Received October 15, 1998; revised manuscript received December 17, 1998; accepted December 21, 1998 Report of a CaseTomoe Katoh, MD; Yoshitaka Ikeda, MD; Hidenori Gohra, MD; Kimikazu Hamano, MD; Yoshihiko Fujimura, MD; Kensuke Esato, MD; Akihiko Aoki, MD*; Katsusuke Naito, MD* To the best of our knowledge, only 3 cases of coronary artery bypass grafting (CABG) performed under cardiopulmonary bypass (CPB) on patients in the chronic phase after renal transplantation have been reported in Japan. The first case of a patient who underwent CABG in the acute phase after renal implantation in Japan is herein described. Perioperatively, oral immunosuppressive agents were discontinued and they were given intr...

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“…The principle post-operation complications are bleeding and infection and the overall mortality related to surgery is 8-10% [1]. Christoph Dresler reported that patients with functioning renal allografts undergoing open heart operations have acceptably low mortality and morbidity rates [1]. Cardiac diagnostic studies and necessary open heart operations should be performed without delay when cardiac symptoms occur.…”

Section: Commentmentioning

confidence: 99%