Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Ann Thorac Surg. 2021 Feb;111(2):568-575. doi: 10.1016/j.athoracsur.2020.05.077. Epub 2020 Jul 9.
Cardiac risk stratification and coronary angiography are routinely performed as part of kidney and liver transplant candidacy evaluation. There are limited data on the outcomes of surgical coronary revascularization in this patient population. This study investigated outcomes in patients with end- stage renal or hepatic disease who were undergoing coronary artery bypass grafting (CABG) to attain kidney or liver transplant candidacy.
This study was a retrospective analysis of all patients who underwent isolated CABG at our institution, Indiana University School of Medicine (Indianapolis, IN), between 2010 and 2016. Patients were divided into 2 cohorts: pretransplant (those undergoing surgery to attain renal or hepatic transplant candidacy) and nontransplant (all others). Baseline characteristics and postoperative outcomes were compared between the groups.
A total of 1801 patients were included: 28 in the pretransplant group (n = 22, kidney; n = 7, liver) and 1773 in the nontransplant group. Major adverse postoperative outcomes were significantly greater in the pretransplant group compared with the nontransplant group: 30-day mortality (14.3% vs 2.8%; P = .009), neurologic events (17.9% vs 4.8%; P = .011), reintubation (21.4% vs 5.8%; P = .005), and total postoperative ventilation (5.2 hours vs 5.0 hours; P = .0124). The 1- and 5-year mortality in the pretransplant group was 17.9% and 53.6%, respectively. Of the pretransplant cohort, 3 patients (10.7%) underwent organ transplantation (all kidney) at a mean 436 days after CABG. No patients underwent liver transplantation.
Outcomes after CABG in pre-kidney transplant and pre-liver transplant patients are poor. Despite surgical revascularization, most patients do not ultimately undergo organ transplantation. Revascularization strategies and optimal management in this high-risk population warrant further study.
在肾脏和肝脏移植候选评估中，通常会进行心脏风险分层和冠状动脉造影。在该患者人群中，关于外科冠状动脉血运重建的结果数据有限。本研究调查了接受冠状动脉旁路移植术（CABG）以获得肾脏或肝脏移植候选资格的终末期肾病或肝病患者的结局。
本研究回顾性分析了 2010 年至 2016 年期间在印第安纳大学医学院（印第安纳波利斯，IN）接受单纯 CABG 的所有患者。患者分为 2 组：移植前组（那些接受手术以获得肾脏或肝脏移植候选资格的患者）和非移植组（所有其他患者）。比较两组患者的基线特征和术后结局。
共纳入 1801 例患者：移植前组 28 例（n=22 例，肾脏；n=7 例，肝脏），非移植组 1773 例。移植前组的主要不良术后结局明显高于非移植组：30 天死亡率（14.3% vs 2.8%；P=0.009）、神经系统事件（17.9% vs 4.8%；P=0.011）、再插管（21.4% vs 5.8%；P=0.005）和总术后通气时间（5.2 小时 vs 5.0 小时；P=0.0124）。移植前组 1 年和 5 年死亡率分别为 17.9%和 53.6%。移植前组 3 例患者（10.7%）在 CABG 后平均 436 天接受了器官移植（均为肾脏）。无患者行肝脏移植。
移植前肾脏和移植前肝脏患者 CABG 后的结局较差。尽管进行了外科血运重建，但大多数患者最终并未进行器官移植。该高危人群的血运重建策略和最佳管理需要进一步研究。
