Kidney-pancreas transplant recipients experience higher risk of complications compared to the general population after undergoing coronary artery bypass grafting
J. M. Perdue1, A. C. Ortiz, BS2, A. Parsikia, MD, MPH1, J. Ortiz, MD1
1Department of Surgery, University of Toledo College of Medicine, Toledo, OH, USA
2Albany Medical College, Albany, NY, USA
Running title: KPT Recipients CABG Complications
Keywords: Transplant, Coronary Artery Disease
Address for Correspondence:
Jordyn Michelle Perdue, BS
Department of Surgery, University of Toledo Medical Center
3000 Arlington Ave., Toledo, Ohio 43614
Jordyn.Perdue@rockets.utoledo.edu
T: (419) 383-6462, F: (419) 383-3348
The authors do not have any sources of funding or conflicts of interest to disclose.
Abstract
Background: This retrospective analysis aims to identify differences in surgical outcomes between pancreas and/or kidney transplant recipients compared to the general population undergoing CABG.
Methods: Using NIS data from 2005 to 2014, patients who underwent CABG were stratified by either no history of transplant, or history of pancreas and/or kidney transplant. Multivariate analysis was used to calculate odds ratio (OR) to evaluate in-hospital mortality, morbidity, length of stay (LOS), and total hospital charge in all centers.
Results: Overall, 2,678 KTx, 184 PTx, 254 KPTx, and 1,796,186 Non-Tx met inclusion criteria. KPTx experienced higher complication rates compared to Non-Tx (78.3% vs. 47.8%, p<0.01). Those with PTx incurred greater total hospital charge and LOS. On weighted multivariate analysis, KPTx was associated with an increased risk for developing any complication following CABG (OR 3.512, p<0.01) and emergency CABG (3.707, p<0.01). This risk was even higher at transplant centers (CABG OR 4.302, p<0.01; emergency CABG OR 10.072, p<0.001). KTx was associated with increased in-hospital mortality following emergency CABG, while PTx and KPTx had no mortality to analyze.
Conclusion: KPTx experienced a significantly higher risk of complications compared to the general population after undergoing CABG, in both transplant and non-transplant centers. These outcomes should be considered when providing perioperative care.
Introduction:
Kidney transplant is the standard intervention for ESRD. In transplant recipients, cardiovascular disease (CVD) is the leading cause of death with functioning graft1,2. Kidney transplant recipients are at an increased risk for CVD for several reasons. Diabetes and hypertension associated with kidney disease are independent CVD risk factors. Additionally, the resultant kidney failure leads to arterial calcification and metabolic derangements3. ESRD increases the risk of CAD by more than 50%4 and kidney potential transplant recipients wait longer for organs. Following transplantation, immunosuppressive regimens themselves accelerate underlying coronary artery disease3,5-7. The risk of CVD may be highest early after transplantation, with incidence up to 11% at 3 years after1,8,9.
The addition of pancreas transplantation limits diabetic complications, improves lipid profile, and enhances quality of life for type 1 diabetics with renal failure10-15. The normalization of blood glucose levels reduces progression of atherosclerosis, and by extension, lowers the risk of CVD12,13. Kidney-pancreas transplant recipients show improved survival compared to those who remain on dialysis14,15. Likely as a result, the number of kidney-pancreas transplants in 2019 were the highest recorded in over a decade16.
As post-transplant survival improves, those with kidney and pancreas transplants are likely to undergo CABG due to increased pre- and post-transplant risk of CVD. It is estimated that there are nearly 400,000 CABG operations performed annually in the United States17. While renal transplant appears to be the most well-researched organ in terms of outcomes and surgical complications, less is known about the risks in pancreas and kidney-pancreas transplants. Previous literature evaluating outcomes in abdominal organ transplants undergoing cardiac surgery has yielded variable results3,7. Surgical outcomes in pancreas and kidney-pancreas transplant recipients undergoing CABG requires further exploration.
Due to the risk of developing coronary artery disease, there is increased need to identify outcomes in kidney and pancreas transplant recipients undergoing CABG. We aim to evaluate in-hospital mortality, complications, length of stay (LOS), and total hospital charges in both transplant and non-transplant centers. Understanding these outcomes in this unique population is critical to improve perioperative and post-operative care as the need for CABG in transplant recipients grows.
Materials and Methods