IMR Press / RCM / Volume 21 / Issue 4 / DOI: 10.31083/j.rcm.2020.04.192
Open Access Systematic Review
Cardiac surgery outcomes in patients with antecedent kidney, liver, and pancreas transplantation: a meta-analysis
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1 Department of Cardiovascular Surgery - Cardiovascular Diseases Institute, and “Grigore T. Popa” University of Medicine, 700115, Iasi, Romania
2 Department of Interventional Cardiology - Cardiovascular Diseases Institute, and “Grigore T. Popa” University of Medicine, 700115, Iasi, Romania

These authors contributed equally.

Rev. Cardiovasc. Med. 2020 , 21(4), 589–599; https://doi.org/10.31083/j.rcm.2020.04.192
Submitted: 20 September 2020 | Revised: 29 October 2020 | Accepted: 4 November 2020 | Published: 30 December 2020
Abstract

Cardiovascular events are among the most common causes of late death in the transplant recipient (Tx) population. Moreover, major cardiac surgical procedures are more challenging and risky due to immunosuppression and the potential impact on the transplanted organ’s functional capacity. We aimed to assess open cardiac surgery safety in abdominal solid organ transplant recipients, comparing the postoperative outcomes with those of nontransplant (N-Tx) patients. Electronic databases of PubMed, EMBASE, and SCOPUS were searched. The endpoints were: overall rate of infectious complications (wound infection, septicemia, pneumonia), cardiovascular and renal events (stroke, cardiac tamponade, acute kidney failure), 30-days, 5-years, and 10-years mortality post-cardiac surgery interventions in patients with and without prior solid organ transplantation. This meta-analysis included five studies. Higher rates of wound infection (Tx vs. N-Tx: OR: 2.03, 95% CI: 1.54 to 2.67, I2 = 0%), septicemia (OR: 3.91, 95% CI: 1.40 to 10.92, I2 = 0%), cardiac tamponade (OR: 1.83, 95% CI: 1.28 to 2.62, I2 = 0%) and kidney failure (OR: 1.70, 95 %CI: 1.44 to 2.02, I2 = 89%) in transplant recipients were reported. No significant differences in pneumonia occurrence (OR: 0.95, 95% CI: 0.71 to 1.27, I2 = 0%) stroke (OR: 0.89, 95% CI: 0.54 to 1.48, I2 = 78%) and 30-day mortality (OR: 1.92, 95% CI: 0.97 to 3.80, I2 = 0%) were observed. Surprisingly, 5-years (OR: 3.74, 95% CI: 2.54 to 5.49, I2 = 0%) and 10-years mortality rates were significantly lower in the N-Tx group (OR: 3.32, 95% CI: 2.35 to 4.69, I2 = 0%). Our study reveals that open cardiac surgery in transplant recipients is associated with worse postoperative outcomes and higher long-term mortality rates.

Keywords
Cardiac surgery
heart surgery
solid organ transplantation
liver transplantation
kidney transplantation
pancreas transplantation
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