OUTCOME OF CORONARY-ARTERY BYPASS-SURGERY IN DIABETIC TRANSPLANT CANDIDATES

Insulin-dependent diabetic (IDDM) patients with end-stage renal diseas e and coronary artery stenoses greater than or equal to 75% have a poo r prognosis. However, information is lacking on the morbidity and mort ality of the coronary artery bypass operation in this group. We studie d 30 consecutive IDDM transplant candidates undergoing a bypass operat ion to determine the incidence of complications and long-term outcome. Perioperative mortality was 3% and the complication rate was 60%. Dur ing follow-up, five patients experienced six myocardial infarctions, t he majority within six months of operation. Twenty-one patients underw ent successful kidney transplantation after the bypass operation. Over all patient survival was 80%, 73%, and 66% at 1, 2 and 4 yr. In summar y, the coronary artery bypass procedure in IDDM transplant candidates has a high morbidity, but the long-term outcome is good. Appropriately counseled IDDM transplant candidates with coronary artery disease sho uld be considered for coronary revascularization and subsequent transp lantation.