Cardiac Surgery and Postoperative Renal Allograft Failure. Ann Thorac Surg 2020 Dec;110(6):1904-1908
Date
04/29/2020Pubmed ID
32343950DOI
10.1016/j.athoracsur.2020.03.066Scopus ID
2-s2.0-85087890222 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
BACKGROUND: Although cardiac surgery among renal allograft recipients is relatively safe, less is known about the impact of cardiac surgery on the functioning renal allograft. This study assessed postoperative renal failure among renal transplant recipients undergoing cardiac surgery.
METHODS: The study population was identified by matching medical record numbers from the United Network for Organ Sharing Kidney Transplant Database to a cardiovascular surgery database and The Society of Thoracic Surgeons Adult Cardiac Surgery Database for the authors' institution from January 1992 through AugustĀ 2018.
RESULTS: One hundred seventy-nine renal transplant recipients with a functioning allograft underwent cardiac surgery a mean of 6.4 Ā± 5.6 years after renal transplantation. Thirty (17.6%) of the 170 patients either died or had allograft failure during the first postoperative year. Receiver-operating characteristics curve analysis using Cox regression demonstrated an optimal cutoff point for preoperative serum creatinine predicting postoperative allograft loss is 1.9 mg/dL (hazard ratio 3; 95% confidence interval, 1.5 to 6.9) with a model C statistic of 0.642.
CONCLUSIONS: The current study affirms findings in the literature that cardiac surgery in renal transplant recipients carries acceptable perioperative morbidity and mortality. Renal transplant recipients who underwent cardiac surgery had a constant hazard of renal allograft loss similar to that of the general transplant population. A preoperative serum creatinine value greater than 1.9 mg/dL increases the risk for long-term renal allograft loss after cardiac surgery.
Author List
Mace JE, Xie R, Deng L, Asban A, Kim W, Pereira SJ, Kirklin JK, Davies JEAuthor
James E. Mace MD Adjunct Assistant Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Cardiac Surgical Procedures
Creatinine
Female
Graft Survival
Humans
Kidney Transplantation
Male
Middle Aged
Postoperative Complications
Predictive Value of Tests
ROC Curve
Renal Insufficiency
Survival Rate
Time Factors