Strengths
By using the NIS national database, we were able to avoid the bias and limited power of a smaller, single-institution study. Additionally, this permitted multivariable analysis to be performed to evaluate outcomes in transplants vs. non-transplant centers. Cardiac surgery has mostly been most studied in kidney and kidney-pancreas transplants, but also under the umbrella of solid abdominal organ transplant, which could also include pancreas and liver. By separating kidney, pancreas, and kidney-pancreas into independent groups, we evaluated outcomes specifically to each group. This appears to be the largest national investigation of CABG and emergency CABG outcomes in kidney and pancreas transplant recipients to date. It is not known from the NIS data whether the kidney-pancreas transplants are simultaneous pancreas-kidney transplant (SPKT) or pancreas-after-kidney (PAK), which may pose an interesting point of further research.
Conclusion
CABG is a common operation, and transplanted patients are increasingly likely to develop CVD. Kidney-pancreas transplant recipients showed significantly greater risk to develop a postoperative complication after CABG and emergency CABG, regardless of transplant center status. Surgeons should be aware of the perioperative risks of KPTx undergoing CABG. Delaying surgery is likely to increase the need for emergent operations, thereby increasing complications. In this analysis, in-hospital mortality was not affected in KPTx. However, it is not known how long-term outcomes are impacted as a result of perioperative morbidity. Further research should continue to evaluate risk factors for morbidity and mortality in transplant patients undergoing cardiac procedures.
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