In-Hospital Cardiovascular Complications Following Pancreas Transplantation in the United States from 2003 to 2012

• Published in: The American journal of cardiology 2017
• Main Authors: Kim, Jim, MD, Schulman-Marcus, Joshua, MD, Watkins, Anthony C., MD, Feldman, Dmitriy N., MD, Swaminathan, Rajesh, MD, Lee, Jun B., MD, Muthukumar, Thangamani, MD, Serur, David, MD, Kim, Luke, MD, Hartono, Choli, MD
• Format: Article
• Language: English
• Subjects: Cardiovascular
• ISSN: 0002-9149
• DOI: 10.1016/j.amjcard.2017.05.038

Abstract Large database studies detailing the risk of perioperative cardiovascular complications after pancreas transplant has been limited, perhaps because these outcomes are not captured by transplant registries. Greater data on the incidence and risks of such outcomes could provide additional insight for referring physicians and inform potential recipients of their risk. We performed a serial, cross-sectional analysis of the National Inpatient Sample, the largest publicly available inpatient database in the United States (US), to assess for the risk of cardiovascular complications following pancreas transplants in the US from 2003 to 2012 (n = 13,399). Using multivariable logistic regression models, the risk of cardiovascular outcomes following simultaneous pancreas-kidney transplants (SPK) was compared to solitary pancreas transplants (pancreas after kidney and pancreas transplant alone [PAK+PTA]). The unadjusted prevalence of in-hospital cardiovascular complications was higher in SPK than PAK+PTA (5.5% vs. 3.7%, p < 0.001). After multivariable adjustment, SPK remained associated with significantly higher odds of any cardiovascular complication (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.21-1.80, p = 0.01), and particularly stroke (OR 13.41, CI 4.78-37.63, p < 0.001), compared with PAK+PTA. However, there was no difference in perioperative mortality (OR 0.78, 95% CI 0.54 to 1.12, p = 0.18). In conclusion, these findings highlight the association between uremia and stroke in pancreas transplant patients, as well as the need for improved preoperative cardiac risk assessment and perioperative management, especially in those undergoing SPK.