Outcomes of Cardiac Surgery in Patients after Kidney Transplant

Background: In patients post kidney transplantation who need cardiac surgery, a higher risk of mortality and morbidity is expected, due to their suppressed immunity and predisposition to post-surgery renal failure. However, this is a theory that has yet to be confirmed, as there is currently no published data on the outcomes of cardiac surgery in patients who received a kidney transplant.

Aim: To analyze major clinical outcomes of cardiac surgery in patients who previously underwent kidney transplantation.

Methods: between 1/2013- 12/2017, 29 kidney-transplant patients underwent cardiac surgery at Rabin Medical Center. We retrospectively collected data about their surgical outcomes, mortality and complication rate, including sepsis, renal failure and re-exploration for bleedings.

Results: Out of 29 patients, 3 died within 30 days of the surgery, and 12 patients (41.3%) died within the first year. 5 patients (17.2%) needed re-exploration for bleeding in the first 24 hours after surgery. Sepsis with longer ICU hospitalization was reported in 5 patients (17.2%). 8 patients developed renal failure, and 7 of them needed dialysis during their post-operative hospitalization. Patients with higher post-operative creatinine levels were more prone to sepsis, and surprisingly, higher rate of re-exploration for bleeding (Cr >2 in all patients, average Cr = 4.75). There was no association between post-operative morbidity and mortality, and the type of immunosuppression or the drug levels during hospitalization.

Conclusions: Despite its small sample, our study revealed a trend: patients after kidney transplantation who underwent cardiac surgery were more susceptible to post-operative renal failure, infections, sepsis, and were more likely to need reexploration due to bleeding. As a result, post-operative mortality is exceptionally high within this group of patients. This alarming data should be further investigated, but the possibility for higher rate of complications should be taken under consideration by physicians referring these patients for cardiac surgery.