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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