INTRODUCTION AND AIMS: Safety of kidney transplantation after coronary revascularization (CR) has been - and still is - under debate, particularly in the two last decades which have displayed both a growing number of cardiovascular disease in dialysed patients and extended indication for kidney transplantation. Aim of the study was to evaluate mortality of revascularised patients after transplantation in comparison with patients still on the waiting list (WL). The analysis is retrospective and monocentric. METHODS: 87 patients, previously revascularised, waitlisted from 1994 to 2006, were siutable for the study. They were divided into group A (trnsplanted, n = 47) and group B (WL, n = 40), comparable for a panel of well known cardiovascular risk factors (age, sex, BMI, cholesterol, smoke, dialytic age, hypertension). For some other variables as PTH, ejection fraction, vasculopathy, antiaggregating drugs, diabetes, a difference was noted between group A and B at the univariate analysis but a multivariate analysis with Cox regression showed no influence on mortality.T-test for continuous variables, chi-square test for discrete ones and Kaplan-Meyer survival actuarial curves were used for statistics. RESULTS: Overall and, specifically, cardiovascular mortality were both superior in group B vs group A (respectively 18% vs 2 % p = 0,02 and 13% vs 2 % p = 0,05). In order to eliminate a selection bias determined by cardiovascular events possibly occurring during the early WL period, we did not analyse WL patients before their 26th month (median waiting time for transplantation in group A); in fact this could be considered an advantage for group A excluding most critical patients from transplantation.Despite this correction cordiovascular mortality is higher in group B (4 death vs 1, p = 0,02). As for survival in WL (i.e. patients deceased + excluded for cardiovascular reasons) in group B it falls at 50 % after 48 months. CONCLUSIONS: In patients who, after CR, are accepted for the WL, kidney transplantation represents a valid option and offers a better outcome in comparison with survival on dialysis. The high percentage of them who are excluded for death or losing suitability for cardiovascular causes (50 % after 4 years on WL) should be considered a further confirm to the need for a debate about a sort of priority in the allocation process. In fact if they are exposed to uremia for a relatively short period once successfully revascularised they may maximize the survival benefits of transplantation.
Kidney transplantation after myocardial revascularization offers better survival than dialysis
VIGOTTI, FEDERICA NEVE;LAVACCA, ANTONIO;FOP, FABRIZIO;SEGOLONI, Giuseppe
2009-01-01
Abstract
INTRODUCTION AND AIMS: Safety of kidney transplantation after coronary revascularization (CR) has been - and still is - under debate, particularly in the two last decades which have displayed both a growing number of cardiovascular disease in dialysed patients and extended indication for kidney transplantation. Aim of the study was to evaluate mortality of revascularised patients after transplantation in comparison with patients still on the waiting list (WL). The analysis is retrospective and monocentric. METHODS: 87 patients, previously revascularised, waitlisted from 1994 to 2006, were siutable for the study. They were divided into group A (trnsplanted, n = 47) and group B (WL, n = 40), comparable for a panel of well known cardiovascular risk factors (age, sex, BMI, cholesterol, smoke, dialytic age, hypertension). For some other variables as PTH, ejection fraction, vasculopathy, antiaggregating drugs, diabetes, a difference was noted between group A and B at the univariate analysis but a multivariate analysis with Cox regression showed no influence on mortality.T-test for continuous variables, chi-square test for discrete ones and Kaplan-Meyer survival actuarial curves were used for statistics. RESULTS: Overall and, specifically, cardiovascular mortality were both superior in group B vs group A (respectively 18% vs 2 % p = 0,02 and 13% vs 2 % p = 0,05). In order to eliminate a selection bias determined by cardiovascular events possibly occurring during the early WL period, we did not analyse WL patients before their 26th month (median waiting time for transplantation in group A); in fact this could be considered an advantage for group A excluding most critical patients from transplantation.Despite this correction cordiovascular mortality is higher in group B (4 death vs 1, p = 0,02). As for survival in WL (i.e. patients deceased + excluded for cardiovascular reasons) in group B it falls at 50 % after 48 months. CONCLUSIONS: In patients who, after CR, are accepted for the WL, kidney transplantation represents a valid option and offers a better outcome in comparison with survival on dialysis. The high percentage of them who are excluded for death or losing suitability for cardiovascular causes (50 % after 4 years on WL) should be considered a further confirm to the need for a debate about a sort of priority in the allocation process. In fact if they are exposed to uremia for a relatively short period once successfully revascularised they may maximize the survival benefits of transplantation.
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