Cardiac Surgery afer Kidney Transplantation Underwent Immunosuppression Terapy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 MUJun-sheng ¹ , LIXian-shuai ¹ , ZHOUFan ² , ZHANGJian-qun ¹ , BOPing ¹

1. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, P. R. China;
2. Department of Echocardiagraphy, General Hospital of the Chinese People's Armed Police Forces, Beijing 100039, P. R. China;

Corresponding author：

MUJun-sheng, Email: wesleymu@hotmail.com

Keywords：

Cardiac surgery; Kidney transplant; immunosuppression

DOI：

10.7507/1007-4848.20150114

Video：

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Objective To analyze the clinical outcomes of cardiac surgery in patients after kidney transplantation underwent immunosuppression therapy. Methods Clinical data of 6 patients (including 4 males and 2 females aged from 27 to 66 years) undergoing cardiac surgery after kidney transplantation with immunosuppression between January 2011 and October 2013 in Beijing Anzhen Hospital were retrospectively analyzed. Two patients underwent off pump coronary artery bypass grafting, 3 patients underwent aortic valve replacement and 1 patient underwent mitral valve replacement. The interval between kidney transplantation and cardiac operation was 8.5±1.7 years (range, 6-10 years). Results All the operations were performed successfully without in-hospital death and complications. Operation time was 237.0±93.0 min. Cardiopulmonary bypass (CPB) time was 101.3±16.7 min. Aortic cross-clamping time was 75.6±9.7 min. in-hospital stay was 17±6 d. There was a statistical difference in preoperative and postoperative left ventricle ejection fraction (63.5%±4.5% vs. 56.5%±5.8%, P < 0.05), as well as preoperative and postoperative left ventricular enddiastolic diameter (54.5±8.5 mm vs. 43.7±6.8 mm, P < 0.05), but there was no statistical difference in preoperative and postoperative serum creatinine levels (103.7±15.1μmol/L vs. 106.6±34.7μmol/L, P > 0.05). The mean follow-up time of the 6 patients was 4-15 months. The follow-up rate was 100%. All the patients were in cardiac function NYHA classⅠ-Ⅱ. And the quality of life was improved. Conclusion Cardiac operations for kidney transplant recipients undergoing immunosuppressive treatment are effective and safe as long as appropriate perioperative treatment are taken.

Citation： MUJun-sheng, LIXian-shuai, ZHOUFan, ZHANGJian-qun, BOPing. Cardiac Surgery afer Kidney Transplantation Underwent Immunosuppression Terapy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(5): 434-437. doi: 10.7507/1007-4848.20150114 Copy

1.	Rostand SG, Kirk KA, Rutsky EA. Dialysis associated ischemic heart disease:insights from coronary angiography. Kidney int, 1984, 25(6):653-659.
2.	Almirall J, Vaqueiro M, Anton E, et al. Prevalence of chronic kidney disease in community dwelling elderly and associated cardiovascular risk factors. Nephrologia, 2005, 25(7):655-662.
3.	Jurkovitz CT, Abramson JL, Vaccarino LV, et al. Association of high serum creatinine and anemia increases the risk of coronary events:Results from the prospective community-based atherosclerosis risk in communities (ARiC) study. J Am Soc Nephrol, 2003, 14(11):2919-2925.
4.	Herzog CA, Littrell K, Arko C, et al. Clinical characteristics of dialysis patients with acute myocardial infarction in the United States:A collaborative project of the United States Renal Data System and the National Registry of Myocardial infarction. Circulation, 2007, 116(13):1465-1472.
5.	王旭冬, 车妙琳, 谢波, 等.术前合并肾功能不全心脏手术患者的预后及相关危险因素分析.中国胸心血管外科临床杂志, 2013, 20(3):278-283.
6.	张希涛, 苏丕雄, 刘岩, 等.非体外循环冠状动脉旁路移植术在肾功能不全患者中的应用.中国胸心血管外科临床杂志, 2003, 10(4):300-301.
7.	Apple FS, Murakami MM, Pearce LA. Predictive value of cardiac troponin i and T for subsequent death in end-stage renal disease. Circulation, 2002, 106(23):2941-2945.
8.	Cardarelli F, Bellasi A, Ou FS, et al. Combined impact of age and estimated glomerular fltration rate on in-hospital mortality afer percutaneous coronary intervention for acute myocardial infarction (from the American College of Cardiology National Cardiovascular Data Registry). Am J Cardiol, 2009, 103(6):766-771.
9.	McCullough PA, Maynard RC. Treatment disparities in acute coronary syndromes, heart failure, and kidney disease. Contrib Nephrol, 2011, 171(2):68-73.
10.	McCullough PA, Verrill TA. Cadiorenal interaction:opprop riate treatment of cardiovascular risk factors to improve outcomes in chronic kidney disease. Postgrad Med, 2010, 122(2):25-34.
11.	Dresler C, Uthoff K, Wahlers T, et al. Open heart operations afer renal trans-plantation. Ann Torac Surg, 1997, 63(1):143-146.
12.	Shafei H, Briggs JD, Bain WH. Follow-up afer coronary revascularisation in patients with renal transplants. Eur J Cardiothorac Surg, 1989, 3(3):262-266.
13.	Owczarek A, Babińska M, Szyguła-Jurkiewicz B, et al. Chronic inflammation in patients with acute coronary syndrome and chronic kidney disease. Kardiol Pol, 2011, 69(4):388-393.
14.	Snell Gi, Westall GP, Paraskeva MA. immunosuppression and allograf rejection following lung transplantation:evidence to date. Drugs, 2013, 73(16):1793-1813.
15.	Legris T, Picard C, Moal V, et al. Humoral immunity afer kidney transplantation:impact of two randomized immunosuppressive protocols. Ann Transplant, 2013, 15(18):622-634.
16.	Knorr JP, Sjeime M, Braitman LE, et al. Concomitant proton pump inhibitors with mycophenolate mofetil and the risk of rejection in kidney transplant recipients. Transplantation, 2013, 24(10):724-730.
17.	Ono M, Wolf RK, Angouras DC, et al. Short-and long-term results of open heart surgery in patients with abdominal solid organ transplant. Eur J Cardiothorac Surg, 2002, 21(6):1061-1072.
18.	Barete S, Calvez V, Mouquet C, et al. Clinical features and contribution of virological fndings to the management of Kaposi sarcoma in organ-allograf recipients. Arch Dermatol, 2000, 136(12):1452-1458.
19.	张晓莉, 徐莹, 李勇.免疫抑制药物在抗移植排斥反应过程中的应用.中国组织工程研究与临床修复, 2011, 15(53):10023-10026.
20.	Golan M, Goor DA, Jacob ET. Coronary artery bypass surgery in a cadaver kidney transplant recient. int Surg, 1987, 72(1):56-57.
21.	inrig JK, Patel UD, Briley LP, et al. Mortality, kidney disease and cardiac procedures following acute coronary syndrome. Nephrol Dial Transplant, 2008, 23(3):934-940.
22.	Defraigne JO, Meurisse M, Limet R. Valvular and coronary bypass surgery in renal transplant patients. J Thorac Cardiovasc Surg, 1990, 31(6):581-583.
23.	Bolman RMⅢ, Anderson RW, Molina JE, et al. Cardiac operations in patients with functioning renal allografs. J Torac Cardiovasc Surg, 1984, 88(5):537-543.

1. Rostand SG, Kirk KA, Rutsky EA. Dialysis associated ischemic heart disease:insights from coronary angiography. Kidney int, 1984, 25(6):653-659.
2. Almirall J, Vaqueiro M, Anton E, et al. Prevalence of chronic kidney disease in community dwelling elderly and associated cardiovascular risk factors. Nephrologia, 2005, 25(7):655-662.
3. Jurkovitz CT, Abramson JL, Vaccarino LV, et al. Association of high serum creatinine and anemia increases the risk of coronary events:Results from the prospective community-based atherosclerosis risk in communities (ARiC) study. J Am Soc Nephrol, 2003, 14(11):2919-2925.
4. Herzog CA, Littrell K, Arko C, et al. Clinical characteristics of dialysis patients with acute myocardial infarction in the United States:A collaborative project of the United States Renal Data System and the National Registry of Myocardial infarction. Circulation, 2007, 116(13):1465-1472.
5. 王旭冬, 车妙琳, 谢波, 等.术前合并肾功能不全心脏手术患者的预后及相关危险因素分析.中国胸心血管外科临床杂志, 2013, 20(3):278-283.
6. 张希涛, 苏丕雄, 刘岩, 等.非体外循环冠状动脉旁路移植术在肾功能不全患者中的应用.中国胸心血管外科临床杂志, 2003, 10(4):300-301.
7. Apple FS, Murakami MM, Pearce LA. Predictive value of cardiac troponin i and T for subsequent death in end-stage renal disease. Circulation, 2002, 106(23):2941-2945.
8. Cardarelli F, Bellasi A, Ou FS, et al. Combined impact of age and estimated glomerular fltration rate on in-hospital mortality afer percutaneous coronary intervention for acute myocardial infarction (from the American College of Cardiology National Cardiovascular Data Registry). Am J Cardiol, 2009, 103(6):766-771.
9. McCullough PA, Maynard RC. Treatment disparities in acute coronary syndromes, heart failure, and kidney disease. Contrib Nephrol, 2011, 171(2):68-73.
10. McCullough PA, Verrill TA. Cadiorenal interaction:opprop riate treatment of cardiovascular risk factors to improve outcomes in chronic kidney disease. Postgrad Med, 2010, 122(2):25-34.
11. Dresler C, Uthoff K, Wahlers T, et al. Open heart operations afer renal trans-plantation. Ann Torac Surg, 1997, 63(1):143-146.
12. Shafei H, Briggs JD, Bain WH. Follow-up afer coronary revascularisation in patients with renal transplants. Eur J Cardiothorac Surg, 1989, 3(3):262-266.
13. Owczarek A, Babińska M, Szyguła-Jurkiewicz B, et al. Chronic inflammation in patients with acute coronary syndrome and chronic kidney disease. Kardiol Pol, 2011, 69(4):388-393.
14. Snell Gi, Westall GP, Paraskeva MA. immunosuppression and allograf rejection following lung transplantation:evidence to date. Drugs, 2013, 73(16):1793-1813.
15. Legris T, Picard C, Moal V, et al. Humoral immunity afer kidney transplantation:impact of two randomized immunosuppressive protocols. Ann Transplant, 2013, 15(18):622-634.
16. Knorr JP, Sjeime M, Braitman LE, et al. Concomitant proton pump inhibitors with mycophenolate mofetil and the risk of rejection in kidney transplant recipients. Transplantation, 2013, 24(10):724-730.
17. Ono M, Wolf RK, Angouras DC, et al. Short-and long-term results of open heart surgery in patients with abdominal solid organ transplant. Eur J Cardiothorac Surg, 2002, 21(6):1061-1072.
18. Barete S, Calvez V, Mouquet C, et al. Clinical features and contribution of virological fndings to the management of Kaposi sarcoma in organ-allograf recipients. Arch Dermatol, 2000, 136(12):1452-1458.
19. 张晓莉, 徐莹, 李勇.免疫抑制药物在抗移植排斥反应过程中的应用.中国组织工程研究与临床修复, 2011, 15(53):10023-10026.
20. Golan M, Goor DA, Jacob ET. Coronary artery bypass surgery in a cadaver kidney transplant recient. int Surg, 1987, 72(1):56-57.
21. inrig JK, Patel UD, Briley LP, et al. Mortality, kidney disease and cardiac procedures following acute coronary syndrome. Nephrol Dial Transplant, 2008, 23(3):934-940.
22. Defraigne JO, Meurisse M, Limet R. Valvular and coronary bypass surgery in renal transplant patients. J Thorac Cardiovasc Surg, 1990, 31(6):581-583.
23. Bolman RMⅢ, Anderson RW, Molina JE, et al. Cardiac operations in patients with functioning renal allografs. J Torac Cardiovasc Surg, 1984, 88(5):537-543.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Cardiac Surgery afer Kidney Transplantation Underwent Immunosuppression Terapy

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