Transplant Evidence Alert

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Cardiac surgery outcomes in patients with antecedent kidney, liver, and pancreas transplantation: a meta-analysis

Rev Cardiovasc Med. 2020 Dec 30;21(4):589-599 doi: 10.31083/j.rcm.2020.04.192.
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.

CET Conclusion
Reviewer: Dr Liset Pengel, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford
Conclusion: The systematic review compared postoperative outcomes of cardiac surgery in abdominal solid organ transplant recipients versus nontransplant patients. A comprehensive search of three bibliographic databases was conducted and two independent reviewers identified five comparative studies to include in kidney, liver, pancreas and pancreas-kidney transplantation. Two independent reviewers extracted the data and methodological quality was also assessed although it was not stated whether this was done by independent reviewers. All studies were considered to be of good methodological quality. Transplant recipients experienced worse postoperative outcomes, i.e. higher rates of wound infection, septicaemia, cardiac tamponate, kidney failure, and 5-year and 10-year mortality. No differences were found for pneumonia, post-procedural stroke rate and 30-day mortality. Heterogeneity was low for most analyses.
Study Details
Aims: This study aimed to compare cardiac surgery outcomes in abdominal solid organ transplant patients versus nontransplant (N-Tx) patients.
Interventions: Electronic databases including Pubmed, SCOPUS and EMBASE were searched. Study screening and data extraction were perfomed by two reviewers. The Newcastle-Ottawa Quality Assessment Scale for cohort studies was used to assess the risk of bias.
Participants: 5 studies were included in the review.
Outcomes: The main endpoints included overall infectious complication rate, cardiovascular and renal events, and mortality following cardiac surgery in patients with prior solid organ transplantation versus nontransplant patients.
Follow Up: N/A
Metadata
Funding: Funding not described
Publication type: Meta-Analysis, Systematic Review
Organ: Various; Kidney; Liver; Pancreas; Simultaneous Kidney/Pancreas
Language: English
Author email: alexandru.burlacu@umfiasi.ro
MeSH terms: Aged; Cardiac Surgical Procedures; Female; Humans; Kidney Transplantation; Liver Transplantation; Male; Middle Aged; Pancreas Transplantation; Postoperative Complications; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome