Outcomes of Surgical Coronary Revascularization Performed Before Solid Abdominal Organ Transplants

Abstract

Background: Cardiac risk stratification and coronary angiography are routinely performed as part of kidney and liver transplant candidacy evaluation. There are limited data on the outcomes of surgical coronary revascularization in this patient population. We investigated outcomes in patients with end stage renal or hepatic disease undergoing coronary artery bypass grafting (CABG) to attain kidney or liver transplant candidacy.Methods: Retrospective analysis of all patients who underwent isolated CABG at our institution between 2010 and 2016. Patients were divided into two cohorts: Pre-transplant (those undergoing surgery to attain renal or hepatic transplant candidacy) and Non-transplant (all others). Baseline characteristics and postoperative outcomes were compared between groups.Results: A total of 1801 patients were included: 28 in Pre-transplant (n=22 kidney, n=7 liver) and 1773 in Non-transplant. Major adverse postoperative outcomes were significantly greater in Pre-transplant compared to Non-transplant: 30-day mortality (14.3% vs. 2.8%, p=0.009), neurologic events (17.9% vs. 4.8%, p=0.011), re-intubation (21.4% vs. 5.8%, p=0.005) and total postoperative ventilation (5.2 vs. 5.0 hours, p=0.0124). One-and five-year mortality in Pretransplant was 17.9% and 53.6%, respectively. Of the Pre-transplant cohort, three patients (10.7%) underwent organ transplantation (all kidneys) at a mean 436 days after CABG. No patients received liver transplantation. Conclusions:Outcomes following CABG in the pre-kidney and pre-liver transplant population are poor. Despite surgical revascularization, the vast majority of patients do not ultimately undergo transplantation. Revascularization strategies and optimal management in this high-risk population warrants further study.

The Year 2020 in Review: Coronavirus Disease 2019 Cloud and Its Impact Excelling the Clinical Practice

“…Interestingly enough, a study by Matthews et al retrospectively looked at patients preoperatively revascularized prior to their liver or kidney transplant surgeries. 56 Surprisingly, they found that outcomes after CABG in pre-kidney and pre-liver transplants versus nontransplant groups were poor (30-day mortality 14.3% vs 2.8%; P = .009). Also, despite revascularization, majority patients never underwent the desired transplant surgery altogether.…”