Coronary artery bypass grafting in a renal transplant patient: case report

Yıl 2019, Cilt: 5 Sayı: 2, 424 - 427, 04.03.2019

Kıvanç Atılgan , Ertan Demirdaş , Mediha Boran , Zafer Cengiz Er Ferit Çiçekçioğlu

https://doi.org/10.18621/eurj.386681

Cited By: 1

Öz

The
patients with end-stage renal disease have an increased risk of atherosclerosis
and the probability of cardiovascular diseases. Due to the use of
immunosuppressive agents, the patients having renal graft carry an additional
risk of atherosclerosis or endocarditis. A 67-year-old male patient with a
history of renal transplantation was referred to our hospital with a severe
chest pain and dyspnea. After diagnosing severe ischemic coronary artery
disease by coronary angiography, the patient underwent a successful operation
of a single vessel coronary artery bypass grafting (CABG) in beating heart. Up
to 20% of post-renal transplantation mortality is attributed to cardiovascular
diseases. Graft rejection, the need of hemodialysis, perioperative infection
are some of the major complications for renal transplant patients undergoing
CABG surgery. Off-pump CABG (OPCABG) surgery is a less invasive technique in
comparison with CABG with cardiopulmonary bypass (CPB), and protects the
patient from negative effects of CPB such as complement system activation,
inflammatory mediator secretion, thrombocytopenia, clotting disorders. We
recommend to prefer OPCABG and have preoperative prophylaxis in order to avoid
both perioperative infection and renal graft rejection in renal transplant
patients undergoing CABG surgery.

Anahtar Kelimeler

Coronary artery bypass grafting, renal transplant, cardiopulmonary bypass, beating heart, immunosuppressive treatment

Kaynakça

• [1] Taketani S, Fukushima N, Ohtake S, Sawa Y, Nishimura M, Matsuda H. Coronary artery bypassgraft in a renal transplant recipient. Jpn J Thorac Cardiovasc Surg 2000;48:542-4.
• [2] Lansing AM, Masri ZH, Kralakulasingam R, Martin DG. Angina during hemodialysis. Treatment by coronary bypass graft. JAMA 1975;232:736-7.
• [3] Frye EB, Vazziri ND, Martin DC, Frarooqui S. Cardiovascular pathology in renal transplant recipients. J Nat Med Ass 1986;78:1187-91.
• [4] Yao H, Smilovitch M, Cecere R, Sandal S, Paraskevas S, Baran D, et al. Sequential and urgent coronary artery bypass surgery followed by kidney transplantation in a highly sensitized patient with unstable angina. Transplantation 2018;102:e41-2.
• [5] Sakao T, Kashu Y, Nakagawa H, Kajiwara S. Off-pump coronary artery bypass grafting in two renal transplant patients. Jpn J Thorac Cardiovasc Surg 2003;51:678-80.
• [6] Christiansen S, Splittgerber FH, Marggraf G, Claus M, Philipp T, Zerkowski HR, et al. Results of cardiacoperations in five kidney transplant patients. Thorac Cardiovasc Surg 1997;45:75-7.
• [7] Noda H, Fujimura Y, Gohra H, Hamano K, Katoh T, Esato K. Coronary bypass surgery after renal transplantation. Jpn J Thorac Cardiovasc Surg 1999;47:135-40.
• [8] Ando M, Koyanagi H, Endo M, Nishida H, HachidaM, Teraoka S. [A report of two cases of coronary bypass surgery after renal transplantation]. Nihon Kyobu Geka Gakkai Zasshi 1993;41:2126-30. [Article in Japanese]
• [9] Bolman RM 3rd, Anderson RW, Molina JE, SchwartzJS, Levine B, Simmons RL, et al. Cardiac operationsin patients with functioning renal allografts. J Thorac Cardiovasc Surg 1984;88:537-43.