Outcomes of cardiac surgery in a large renal transplant cohort.

Abstract

Purpose: Among patients with end stage renal failure (ESRF), the leading cause of morbidity and mortality remains cardiovascular disease. Renal transplantation (RT) relieves ESRF patients from the need for dialysis and improves outcomes. Given the significant burden of cardiovascular disease in ESRF patients, this study aimed to better inform an understanding of the outcomes of cardiac surgery in a RT cohort. Method(s): A retrospective analysis of prospectively collected data was performed on 7,185 patients who underwent any form of cardiac surgery at a single tertiary institution between 2008 and 2022. Outcomes of interest were renal transplant function, the requirement for post-operative dialysis, mortality, length of stay, and length of Intensive Care Unit (ICU) stay. Result(s): RT patients demonstrated worse general and renal outcomes postoperatively compared with non-ESRF patients, however cardiac outcomes were not significantly affected. Patients with RT experienced longer postoperative hospital stays (18.2+/-17.5 vs 14.0+/-12.0 days, p<0.01), longer postoperative ICU stays (110.7+/-196.9 vs 61.7+/-96.2 hours, p<0.01), higher rate of return to theatre (22.5% vs 7.1%, p<0.01), more newly-developed renal failure (22.5% vs 5.8%, p=0.048), higher postoperative peak creatine (367.3+/-272.9 vs 123.9+/-77.5 mumol/L, p<0.01), and lower postoperative minimum haemoglobin (78.1+/-13.7 vs 87.9+/-15.3 g/L, p<0.01) with increased transfusion requirement. There was no statistically significant difference in post-operative mortality (7.5% vs 3.3%, p=0.15) and cardiovascular outcomes were not significantly affected, including postoperative myocardial infarction (0.0% vs 0.8%, p~1), postoperative atrial fibrillation (30.0% vs 31.1%, p=0.88), and postoperative cerebrovascular events (2.5 vs 1.8%, p=0.53). Conclusion(s): Cardiac surgery conferred more postoperative general and renal complications in RT patients compared to non-ESRF patients, though cardiovascular outcomes were not significantly impacted.Copyright © 2024