Sequential and Urgent Coronary Artery Bypass Surgery Followed by Kidney Transplantation in a Highly Sensitized Patient With Unstable Angina

Yao, Han; Smilovitch, Mark; Cecere, Renzo; Sandal, Shaifali; Paraskevas, Steven; Baran, Dana; Fernandes, Maria Helena Calixto; Saw, Chee Loong; Al‐Mahmeed, Husain; Cantarovich, Marcelo

doi:10.1097/tp.0000000000001954

Transplantation

2018

DOI: 10.1097/tp.0000000000001954

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Sequential and Urgent Coronary Artery Bypass Surgery Followed by Kidney Transplantation in a Highly Sensitized Patient With Unstable Angina

Han Yao

Mark Smilovitch

Renzo Cecere

et al.

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Cited by 2 publications

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“…The European Research Journal 2019;5 (2):424-427 wing to renal transplantation, patients with endstage renal disease have improved a remarkable survey and a better life quality. However, these patients have an increased risk of atherosclerosis and cardiovascular diseases due to the use of immunosuppressive agents [1][2][3][4]. Renal transplant patients undergoing coronary artery bypass grafting (CABG) also are under the risk of higher rates of postoperative complications such as graft rejection, infection or impairment of renal function.…”

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Coronary artery bypass grafting in a renal transplant patient: case report

Atılgan

Demi̇rdaş

Boran

et al. 2019

The European Research Journal

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The patients with end-stage renal disease have an increased risk of atherosclerosis and the probability of cardiovascular diseases. Due to the use of immunosuppressive agents, the patients having renal graft carry an additional risk of atherosclerosis or endocarditis. A 67-year-old male patient with a history of renal transplantation was referred to our hospital with a severe chest pain and dyspnea. After diagnosing severe ischemic coronary artery disease by coronary angiography, the patient underwent a successful operation of a single vessel coronary artery bypass grafting (CABG) in beating heart. Up to 20% of post-renal transplantation mortality is attributed to cardiovascular diseases. Graft rejection, the need of hemodialysis, perioperative infection are some of the major complications for renal transplant patients undergoing CABG surgery. Offpump CABG (OPCABG) surgery is a less invasive technique in comparison with CABG with cardiopulmonary bypass (CPB), and protects the patient from negative effects of CPB such as complement system activation, inflammatory mediator secretion, thrombocytopenia, clotting disorders. We recommend to prefer OPCABG and have preoperative prophylaxis in order to avoid both perioperative infection and renal graft rejection in renal transplant patients undergoing CABG surgery.

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mentioning

confidence: 99%

Coronary artery bypass grafting in a renal transplant patient: case report

Atılgan

Demi̇rdaş

Boran

et al. 2019

The European Research Journal

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The Challenges With the Cardiac Evaluation of Liver and Kidney Transplant Candidates

2020

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Cardiovascular events are among the leading cause of mortality in kidney and liver transplant recipients. Thus, screening for cardiovascular disease and risk stratification for cardiovascular events constitute an important part of the pretransplant evaluation. In this review, we first summarize current guidelines in the cardiac risk assessment of kidney and liver transplant candidates. We then elaborate on the limitations of these guidelines, summarize the current knowledge gaps, and narrow down a spectrum of 6 themes that serve as challenges to research and practice development. This spectrum pertains to understanding the disease itself, which is challenging due to the altered cardiac physiology in these patients and current guidelines that do not adequately account for nonischemic diseases and events. We then describe the challenges in assessing these patients, their symptoms, and individualizing their risk of cardiovascular events with a special consideration for nontraditional risk factors. We also explore the limitations of the current and novel diagnostic tests and the lack of evidence of therapeutic efficacy in intervening in patients with asymptomatic disease. The transplant procedure itself can be a potential modifiable risk factor for cardiovascular events, that is, surgical technique, type of donor, and induction immunosuppression. Lastly, we describe the potential issues with the current literature when defining cardiac diseases and events across different studies and shortcomings of extrapolating data from the nontransplant literature. We conclude by proposing research and practice implications of our discussion and that there is a need for evidence to guide the revision of current guidelines.

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Sequential and Urgent Coronary Artery Bypass Surgery Followed by Kidney Transplantation in a Highly Sensitized Patient With Unstable Angina

Cited by 2 publications

References 4 publications

Coronary artery bypass grafting in a renal transplant patient: case report

Coronary artery bypass grafting in a renal transplant patient: case report

The Challenges With the Cardiac Evaluation of Liver and Kidney Transplant Candidates

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