Clinical

Cardiac surgery safe for kidney and liver transplant recipients

Last Updated: 2006-07-18 9:55:14 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Kidney and liver transplant recipients can safely undergo cardiac surgery, according to a report in the July issue of the Mayo Clinic Proceedings.

Renal and hepatic transplant recipients commonly develop cardiovascular disease, the authors explain, but cardiovascular surgeons have often expressed concerns about delayed wound healing, infection, and allograft failure after cardiopulmonary bypass in these patients.

Dr. Charles J. Mullany and colleagues from Mayo Clinic College of Medicine, Rochester, Minnesota evaluated operative management, outcome, and long-term survival after cardiac surgery in 47 patients with functioning renal (n = 34) or hepatic allografts (n = 13).

The surgeries included coronary artery bypass grafting, aortic valve procedures, and mitral valve procedures. There were no intraoperative deaths, the team reports, but two patients required an intra-aortic balloon pump postoperatively and one patient died within 30 days of surgery.

Two patients had leg wound infections, but there were no sternal or mediastinal infections. Seventeen patients (36%) experienced complications not related to their allografts.

Five of the 34 renal patients (15%) had renal allograft dysfunction immediately after surgery, the researchers note, but only 1 of 5 patients that required dialysis still needed dialysis at discharge.

Transiently elevated liver enzyme levels were noted in 6 of the 13 hepatic transplant recipients (46%), the report indicates, but all patients had functional allografts at hospital discharge.

Patients left the hospital after a median stay of 8 days, the results indicate. Late allograft dysfunction developed in 5 renal patients (15%) and 2 hepatic patients (15%), the investigators say.

One-year survival rates were 93% and 97% for renal and hepatic patients, respectively, and five-year survival rates were 76% and 82%, respectively.

"Cardiac surgery can be performed safely in liver and renal transplant recipients," Dr. Mullany and colleagues conclude. "The functional outcomes are good, but significant perioperative morbidity can occur."

Mayo Clin Proc 2006;81:917-922.