Outcomes of Coronary Artery Bypass Grafting for Asymptomatic Patients Referred for Renal Transplant

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2025-03-04 DOI:10.1111/ctr.70128

Enoch J. Wong, Connor M. McDonald, Elizabeth Thomas, Ali Zarrinpar, Lawrence Lee, Karen M. Kim, Thomas M. Beaver, Raja Al-Bahou, Jonathan Gelfond AL, John H. Calhoon, Dawn S. Hui

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Abstract

Background

The optimal management of incidental coronary artery disease (CAD) for renal transplant candidates is not well-defined. This study examined transplant and survival outcomes in patients undergoing coronary artery bypass grafting (CABG) for asymptomatic CAD.

Methods

A retrospective review of patients undergoing CABG solely to facilitate renal transplant was conducted at four tertiary centers. Exclusion criteria were symptoms or acute coronary syndrome (ACS). The primary outcomes were successful renal transplant and survival analyzed using Kaplan-Meier curves with log-rank testing, compared to US Renal Data System (USRDS)-predicted life expectancy matched for age and gender.

Results

86 patients (59.0 [IQR 51.0,65.0] years, 88% male) were identified. At follow-up of 4.41 (2.74,6.04) years, 19.8% (n = 17) had successful renal transplant; 29.1% (n = 25) were never listed, 44.2% (n = 38) listed but removed (29 permanently, 9 temporarily), 7.0% (n = 6) awaiting transplant. Pre- and intraoperative characteristics were similar between those transplanted and not. For the entire cohort, CABG was associated with worse 1-year survival, similar 5-year survival, and better 8-year survival compared to USRDS-predicted life expectancy (log-rank p = 0.027). Considering those not transplanted, 8-year survival was similar to USRDS (log-rank p = 0.94).

Conclusions

In patients with Stage V CKD and asymptomatic CAD, renal transplant rates are low. Whether surgical revascularization offers survival benefit due to successful renal transplant or due to revascularization remains an area of future study. Longer follow-up, study of patient/procedural factors, and multidisciplinary efforts may improve patient selection and transplantation rates.

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无症状患者转介行肾移植的冠状动脉旁路移植术的疗效

背景肾移植候选者偶发性冠状动脉疾病（CAD）的最佳处理尚未明确。本研究检查了无症状冠心病患者接受冠状动脉旁路移植术（CABG）的移植和生存结果。方法回顾性分析4个三级中心单纯为促进肾移植而行冠脉搭桥的患者。排除标准为症状或急性冠脉综合征（ACS）。主要结果是成功的肾移植和生存分析，使用Kaplan-Meier曲线和log-rank检验，与美国肾脏数据系统（USRDS）预测的与年龄和性别匹配的预期寿命进行比较。结果86例患者（59.0 [IQR 51.0,65.0]岁，其中88%为男性）。随访4.41（2.74,6.04）年，19.8% （n = 17）肾移植成功；29.1% （n = 25）未列入名单，44.2% （n = 38）列入名单但被移除（永久移除29例，暂时移除9例），7.0% （n = 6）等待移植。移植和未移植患者术前和术中特征相似。对于整个队列，与usrds预测的预期寿命相比，CABG与更差的1年生存率，相似的5年生存率和更好的8年生存率相关（log-rank p = 0.027）。考虑到未移植的患者，8年生存率与USRDS相似（log-rank p = 0.94）。结论V期CKD合并无症状CAD患者的肾移植率较低。手术血运重建术是否由于成功的肾移植或由于血运重建术而提供生存益处仍是一个未来研究的领域。更长时间的随访、对患者/手术因素的研究和多学科的努力可能会提高患者的选择和移植率。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.