<div>Kidney-pancreas transplant recipients experience higher risk of
complications compared to the general population after undergoing
coronary artery bypass grafting</div><div>J. M. Perdue<sup>1</sup>, A. C. Ortiz, BS<sup>2</sup>, A.
Parsikia, MD, MPH<sup>1</sup>, J. Ortiz, MD<sup>1</sup></div><div><sup>1</sup>Department of Surgery, University of Toledo College
of Medicine, Toledo, OH, USA</div><div><sup>2</sup>Albany Medical College, Albany, NY, USA</div><div>Running title: KPT Recipients CABG Complications</div><div>Keywords: Transplant, Coronary Artery Disease</div><div>Address for Correspondence:</div><div>Jordyn Michelle Perdue, BS</div><div>Department of Surgery, University of Toledo Medical Center</div><div>3000 Arlington Ave., Toledo, Ohio 43614</div><div>Jordyn.Perdue@rockets.utoledo.edu</div><div>T: (419) 383-6462, F: (419) 383-3348</div><div>The authors do not have any sources of funding or conflicts of interest
to disclose.</div><div>Abstract</div><div>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.</div><div>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.</div><div>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&lt;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&lt;0.01) and emergency
CABG (3.707, p&lt;0.01). This risk was even higher at transplant
centers (CABG OR 4.302, p&lt;0.01; emergency CABG OR 10.072,
p&lt;0.001). KTx was associated with increased in-hospital
mortality following emergency CABG, while PTx and KPTx had no mortality
to analyze.</div><div>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.</div><div>Introduction:</div><div>Kidney transplant is the standard intervention for ESRD. In transplant
recipients, cardiovascular disease (CVD) is the leading cause of death
with functioning graft<sup>1,2</sup>. 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 derangements<sup>3</sup>.
ESRD increases the risk of CAD by more than 50%<sup>4</sup> and
kidney potential transplant recipients wait longer for organs. Following
transplantation, immunosuppressive regimens themselves accelerate
underlying coronary artery disease<sup>3,5-7</sup>. The risk of
CVD may be highest early after transplantation, with incidence up to
11% at 3 years after<sup>1,8,9</sup>.</div><div>The addition of pancreas transplantation limits diabetic complications,
improves lipid profile, and enhances quality of life for type 1
diabetics with renal failure<sup>10-15</sup>. The normalization
of blood glucose levels reduces progression of atherosclerosis, and by
extension, lowers the risk of CVD<sup>12,13</sup>.
Kidney-pancreas transplant recipients show improved survival compared to
those who remain on dialysis<sup>14,15</sup>. Likely as a result,
the number of kidney-pancreas transplants in 2019 were the highest
recorded in over a decade<sup>16</sup>.</div><div>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
States<sup>17</sup>. 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 results<sup>3,7</sup>. Surgical outcomes in pancreas and
kidney-pancreas transplant recipients undergoing CABG requires further
exploration.</div><div>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.</div><div>Materials and Methods</div>