10th Congress of the Turkish Transplantation Centers Coordination Association
Renal transplantation
Simultaneous Cardiac Surgery and Renal Transplantation Compared With Renal Transplantation After Cardiac Surgery

https://doi.org/10.1016/j.transproceed.2015.04.024Get rights and content

Abstract

Patients with end-stage renal disease (ESRD) have a high prevalence of coronary artery disease and cardiovascular death. The mortality and the morbidity rates of cardiac surgery are particularly high in these patients with end-stage renal disease. Performing cardiac surgery and kidney transplantation in the same session can reduce these complications in the early postoperative period by normalizing renal function. We compared the mortality and morbidity rates between patients who had undergone cardiac surgery and kidney transplantation separately and patients who had combined surgeries. This retrospective study consisted of 75 patients. One group of 60 patients underwent cardiac surgery and kidney transplantation in separate sessions, and the other group of 15 patients had combined surgeries in the same session, between March 2008 and September 2012. Patients who had combined surgeries achieved fluid electrolytic balance more easily, had shorter extubation times, used less blood and blood products, and had fewer major complications. The patients recovered faster and thus had shorter stays in the intensive care unit and hospital. This combined surgical approach allows normalized kidney function in patients with end-stage renal disease, so mortality and morbidity in the early postoperative period could be significantly reduced.

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Patients and Methods

Ninety-five patients with ESRD who were awaiting a transplant and had coronary artery disease diagnosed after cardiac screening tests in our clinic between March 2008 and August 2014 were analyzed retrospectively and were included in the study.

The patients were arranged into 2 groups: A and B. The separate surgeries group A consisted of 60 patients who had cardiac surgery first and then had renal transplantation surgery in the following 1 to 6 months. The combined surgeries group B consisted of

In-Hospital Mortality

The overall early (30-day) mortality rate was 5.0% in the separate surgeries group A (3 of 60 patients), and zero in the combined surgeries group B. Three of the patients from the separate surgeries group died while in the hospital after the surgery. One of these patients was a 31-year-old woman being treated with insulin for type 2 diabetes; her ejection fraction was 42% and she had undergone CABG and mitral valve replacement. She had been dependent on dialysis for 8 years. Intense inotropic

Discussion

Patients with end-stage renal disease form a high-risk group for cardiac surgery when compared with the general population and this situation adversely affects early and late results of cardiac surgery [7].

Approximately 35% to 50% of deaths in dialysis patients can be attributed to cardiovascular diseases [8].

Cardiac surgery applied to this group of patients incorporates a range of factors that increase mortality and morbidity during the perioperative period [9].

Patients' ability to handle

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