Outcome after myocardial revascularization and renal transplantation - A 25-year single-institution experience

Background and Objective Cardiac disease is a common cause of death in renal transplant recipients. This study retrospectively analyzes the results of myocardial revasculariza tion procedures in these patients and makes recommendations for managing co ronary atherosclerosis in patients with renal disease who already have a tr ansplanted kidney or who may receive a kidney transplant. Methods Patients who had myocardial revascularization (coronary artery bypass graft ing [CABG] or percutaneous transluminal coronary angioplasty [PTCA]) and re nal transplantation at the authors' institution between 1968 and 1994 were analyzed. Patient, procedural, and institutional variables were used for ac tuarial analyses of survival, as well as multivariate analyses of risk fact ors for death. Results Eighty-three of 2989 renal transplant patients required myocardial revascul arization either before or after their transplant, and diabetes mellitus wa s the cause of renal failure in 42% of these patients. Standard coronary an giography, CABG, and PTCA techniques were used without periprocedural renal allograft loss. Actuarial patient survival was 89%, 77%, and 65% at 1, 3, and 5 years after the last procedure (transplantation or revascularization) . Cardiac disease was the most common mode of death. Early-phase risk facto rs for death by multivariate analysis included hypertension and revasculari zation before 1989. Late-phase risk factors for death included diabetes mel litus, higher number of pre-CABG myocardial infarctions, renal transplantat ion before 1984, older age, and unstable angina before CABG. Conclusions Myocardial revascularization can be performed with acceptable short- and lo ng-term results in patients with renal disease who have renal transplantati on either before or after the revascularization procedure. Diabetes mellitu s was a highly prevalent condition among these patients, and cardiac diseas e was their most common mode of death. PTCA and CABG, as performed at this institution, posed little risk for renal allograft loss. Modification of ri sk factors for coronary atherosclerosis, rigorous cardiac evaluation of pat ients at risk for coronary artery disease before renal transplantation, and aggressive use of revascularization procedures to decrease the incidence o f myocardial infarction are proposed as ways to prolong the survival of ren al transplant patients with ischemic heart disease.