Geraldine Diaz1, Michael O'Connor. 1. Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois 60637, USA. gdiaz@dacc.uchicago.edu
Abstract
PURPOSE OF REVIEW: Cardiovascular and renal complications among solid-organ transplant recipients are a frequent source of morbidity. Appropriate management of these complications throughout the perioperative period significantly affects long-term recipient survival. This review details the identification, management, and potential preventive strategies for perioperative cardiovascular and renal complications among solid-organ transplant recipients. RECENT FINDINGS: Abdominal transplant candidates have a significantly higher prevalence of risk factors for obstructive coronary artery disease than the general population. There is no consensus on pretransplant screening for coronary artery disease or determination of perioperative risk in candidates awaiting transplantation. Limitations of noninvasive cardiac screening tests such as dobutamine stress echocardiography and myocardial perfusion scintigraphy complicate preoperative evaluation and cardiac risk stratification. Coronary angiography remains the definitive mechanism for determining the presence and severity of coronary artery disease prior to transplantation; however, the relationship between angiographically documented coronary artery disease and cardiovascular morbidity after transplantation is inconsistent. This has raised speculation that perioperative adverse cardiac events are not principally caused by obstructive coronary artery disease but other acute events related to surgical intervention and allograft function. Current data indicate coronary angiography is safe even with patients demonstrating renal insufficiency. A cardiac screening program should reflect the patient population, dynamics of the transplant program, and institutional expertise. The development of classification schemes for defining and categorizing acute kidney injury reflects the importance of preserved renal function in long-term recipient survival. The potential of serum markers as indicators of acute kidney injury has provided a foundation for understanding the global influence of surgical intervention and allograft function upon recipient survival. SUMMARY: Meticulous attention to all aspects of the transplant process, including operative events and early allograft function, is necessary to minimize morbidity. Further research is necessary to identify mechanisms that support and improve early allograft function to optimize recipient long-term survival.
PURPOSE OF REVIEW: Cardiovascular and renal complications among solid-organ transplant recipients are a frequent source of morbidity. Appropriate management of these complications throughout the perioperative period significantly affects long-term recipient survival. This review details the identification, management, and potential preventive strategies for perioperative cardiovascular and renal complications among solid-organ transplant recipients. RECENT FINDINGS: Abdominal transplant candidates have a significantly higher prevalence of risk factors for obstructive coronary artery disease than the general population. There is no consensus on pretransplant screening for coronary artery disease or determination of perioperative risk in candidates awaiting transplantation. Limitations of noninvasive cardiac screening tests such as dobutamine stress echocardiography and myocardial perfusion scintigraphy complicate preoperative evaluation and cardiac risk stratification. Coronary angiography remains the definitive mechanism for determining the presence and severity of coronary artery disease prior to transplantation; however, the relationship between angiographically documented coronary artery disease and cardiovascular morbidity after transplantation is inconsistent. This has raised speculation that perioperative adverse cardiac events are not principally caused by obstructive coronary artery disease but other acute events related to surgical intervention and allograft function. Current data indicate coronary angiography is safe even with patients demonstrating renal insufficiency. A cardiac screening program should reflect the patient population, dynamics of the transplant program, and institutional expertise. The development of classification schemes for defining and categorizing acute kidney injury reflects the importance of preserved renal function in long-term recipient survival. The potential of serum markers as indicators of acute kidney injury has provided a foundation for understanding the global influence of surgical intervention and allograft function upon recipient survival. SUMMARY: Meticulous attention to all aspects of the transplant process, including operative events and early allograft function, is necessary to minimize morbidity. Further research is necessary to identify mechanisms that support and improve early allograft function to optimize recipient long-term survival.