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Central Surgical Association

49th Annual Meeting

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Long-Term Outcomes of Cardiac Surgery in Prior Solid Organ Transplant Recipients
Chesney Siems1, Scott Jackson4, Jando Danial2, Andrew Shaffer1, Sara Shumway1, Raja Kandaswamy3, Ranjit John1
1Department of Cardiothoracic Surgery, University of Minnesota, Edina, Minnesota, United States, 2University of Minnesota Medical School, Minneapolis, Minnesota, United States, 3Department of Surgery, Division of Transplantation, University of Minnesota, Minneapolis, Minnesota, United States, 4Analytics Consulting Services, Solid Organ Transplant, University of Minnesota Medical Center Fairview, Minneapolis, Minnesota, United States

Cardiac surgery has become common in patients with prior solid organ transplants (SOT). These patients are at higher risk for adverse outcomes after cardiac surgery given ongoing immunosuppression and higher rates of comorbid conditions. Previous studies include few patients with prior pancreas or combination SOT given the infrequency at many institutions. We sought to look at long-term outcomes in SOT patients undergoing cardiac surgery.

156 patients with previous abdominal SOT underwent cardiac surgery at our institution from January 2000 through September 2021. 141 patients had transplants in our system allowing for long-term follow-up and retrospective analysis. We included kidney, liver, pancreas, or any combination of abdominal SOT in our cohort. We included coronary artery bypass graft (CABG), single and multi-valves, CABG/valve, aortic aneurysms, and others. Kaplan-Meier (KM) survival estimates were used to evaluate early and late survival, as well as death censored graft survival. Cox proportional hazards models were used to examine risk factors for graft and patient survival, censored at 10 years.

Demographic data included mean age 54.5 ± 10.2 years, 59% male, 68% diabetes, 47.5% preop renal failure, and 36% history of smoking. SOT included 86 (61%) kidney, 20 (14%) pancreas, 16 (11%) liver, 14 (10%) kidney-pancreas, 4 (3%) liver-kidney, and 1 kidney-auto islet transplantation. 66% of patients had one prior SOT; remaining had multiple prior SOT. 39 (27%) patients had an already failed renal graft prior to cardiac surgery. Cardiac surgeries included 75 (53%) CABG, 21 (15%) valve, 8 (6%) CABG + valve, 8 (6%) multiple valves, 3 (2%) aortic, and 26 (18%) others. 80 (56.7%) were elective, 57 (40%) urgent, and 4 (3%) emergent. KM patient survival was 93% (95% CI 89.6-97.7), 51% (95% CI 43.3-61.2), and 37.6% (95% CI 29.6-47.7) at 30-days, 5-years, and 10-years, respectively. Risk factors for mortality at 10-years included preoperative renal failure (adjusted HR 2.03, 95% CI 1.13-3.65, p=0.017), emergent operation (adjusted HR 4.85, 95% CI 1.05-22.46, p=0.043), and postoperative dialysis (adjusted HR 2.15, 95% CI 1.04-4.44, p=0.038). Of 102 patients with functional grafts at time of cardiac surgery, graft survival was 96% (95% CI 92.2-99.9), 58% (95% CI 48.1-71.2), and 49% (95% CI 38.2-64.0) at 30-days, 5-years, and 10-years, respectively. Risk factors for graft failure included need for postoperative dialysis (adjusted HR 5.30, 95% CI 1.97-14.25, p=0.001).

Patients undergoing cardiac surgery with prior abdominal SOT have acceptable short and long term survival. Preoperative renal failure, emergent operation, and postoperative dialysis were identified as significant risk factors for mortality. These data may help strategize management options for cardiac disease in this group of patients and allow for improved preoperative counseling.

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