CARDIAC-SURGERY IN RENAL-TRANSPLANT PATIENTS - REPORT OF A SERIES OF 24 CASES

Results of cardiac surgery in renal transplant patients are not well d ocumented. Immunosuppression as well as associated conditions in these patients, and the increased susceptibility of the renal allograft to the extracorporeal circulation (ECC) may alter the prognosis of renal transplant patients submitted to cardiac surgery. To evaluate this hyp othesis, we reviewed the files of 24 patients (18 male, 6 female; age: 49 +/- 12 years) operated under ECC between 1978 and 1997. Twenty pati ents underwent coronary artery bypass surgery, 5 patients a valve repl acement procedure (aortic and/or mitral), and one patient necessitated a Cabrol procedure far an ascending aorta aneurysm. Preoperatively, t he majority of patients were in functional class (NYHA) IV(16 patients ), and ejection fraction was > 50% in 18 patients. Two operative death s secondary to cardiogenic shock were encountered. Five patients (23%) were reoperated for bleeding, 5 patients (23%) sustained a major infe ction (2 pneumonias, 2 mediastinitis and one wound infection) resultin g in death in one patient; 5 patients (23%) were treated for arythmia; and 2 patients (9%) suffered a perioperative myocardial infarction. S erum creatinine levels did not increase significatively during, hospit alization (p = 0,41 between extreme values). Mean follow-up (41 +/- 28 months) of the 20 survivors revealed recurrent angina in 5 patients a nd late death in 4 patients, cardiac-related in 3 cases. Conclusion: C ardiac surgery in renal transplant patients is subjected to a high mor bidity and mortality. Mid-term prognosis is reserved especially in pre sence of associated conditions.