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Original research
Perioperative outcomes and readmissions following cardiac operations in kidney transplant recipients
  1. Josef Madrigal,
  2. Shannon Richardson,
  3. Joseph Hadaya,
  4. Arjun Verma,
  5. Zachary Tran,
  6. Yas Sanaiha,
  7. Peyman Benharash
  1. Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
  1. Correspondence to Dr Peyman Benharash, Division of Cardiac Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA; pbenharash{at}mednet.ucla.edu

Abstract

Objective Although kidney transplant (KTx) recipients are at significant risk for cardiovascular disease, outcomes following cardiac operations have been examined in limited series. The present study thus aimed to assess the impact of KTx on in-hospital perioperative outcomes and readmissions in a nationally representative cohort.

Methods All adults undergoing elective coronary artery bypass grafting, valve repair/replacement or a combination thereof were identified from the 2010–2018 Nationwide Readmissions Database. Patients were stratified by history of KTx. Transplant-capable centres were defined as hospitals performing at least one KTx annually. To perform risk-adjustment in assessing outcomes, multivariable regression models were developed.

Results Of an estimated 1 407 351 patients included for analysis, 0.2% (n=2849) were KTx recipients. Compared with the general cardiac surgical population, patients with prior KTx experienced higher adjusted odds of in-hospital mortality (adjusted OR (AOR) 2.44, 95% CI 1.72 to 3.47, p<0.001) and perioperative complication (AOR 1.67, 95% CI 1.44 to 1.94, p<0.001). Additionally, KTx was independently associated with greater readmission rates within 30 days (AOR 1.96, 95% CI 1.65 to 2.34, p<0.001) with kidney injury contributing significantly to the burden of rehospitalisation (4.6 vs 1.8%, p=0.005). In a subpopulation comprised of only KTx recipients, treatment at a transplant-capable centre reduced odds of kidney injury with non-transplant hospitals as reference (AOR 0.65, 95% CI 0.43 to 0.98, p=0.037).

Conclusions Kidney transplant recipients undergoing cardiac operations encounter significant risks compared with the general surgical population. Referral to transplant-capable centres should be explored to improve outcomes and to preserve allograft function in this population.

  • Cardiac Surgical Procedures
  • Risk Factors
  • Outcome Assessment, Health Care

Data availability statement

Data may be obtained from a third party and are not publicly available. Data cannot be shared directly by the authors because specific approval for data access and completion of a Data Use Agreement is required by the Agency for Healthcare Research and Quality. Data are available from the Agency for Healthcare Research and Quality (contact via www.hcup-us.ahrq.gov) for researchers who meet the criteria for access and complete a Data Use Agreement.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Data cannot be shared directly by the authors because specific approval for data access and completion of a Data Use Agreement is required by the Agency for Healthcare Research and Quality. Data are available from the Agency for Healthcare Research and Quality (contact via www.hcup-us.ahrq.gov) for researchers who meet the criteria for access and complete a Data Use Agreement.

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Footnotes

  • Twitter @JosefTDMadrigal, @DrZacharyTran, @YasSanaiha, @CoreLabUCLA

  • Contributors Project conceptualisation: JM, JH, PB. Statistical analysis: JM, JH, ZT. Data interpretation: all authors. Preparation/drafting of manuscript: all authors. Revision/editing proofread of manuscript: all authors. Guarantor: PB

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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