Outcomes of Coronary Artery Bypass Grafting for Asymptomatic Patients Referred for Renal Transplant

Background: The optimal management of incidental coronary artery disease (CAD) for renal transplant candidates is not well-defined. This study examined transplant and survival outcomes in patients undergoing coronary artery bypass grafting (CABG) for asymptomatic CAD. Methods: A retrospective review of patients undergoing CABG solely to facilitate renal transplant was conducted at four tertiary centers. Exclusion criteria were symptoms or acute coronary syndrome (ACS). The primary outcomes were successful renal transplant and survival analyzed using Kaplan-Meier curves with log-rank testing, compared to US Renal Data System (USRDS)-predicted life expectancy matched for age and gender. Results: 86 patients (59.0 [IQR 51.0,65.0] years, 88% male) were identified. At follow-up of 4.41 (2.74,6.04) years, 19.8% (n = 17) had successful renal transplant; 29.1% (n = 25) were never listed, 44.2% (n = 38) listed but removed (29 permanently, 9 temporarily), 7.0% (n = 6) awaiting transplant. Pre- and intraoperative characteristics were similar between those transplanted and not. For the entire cohort, CABG was associated with worse 1-year survival, similar 5-year survival, and better 8-year survival compared to USRDS-predicted life expectancy (log-rank p = 0.027). Considering those not transplanted, 8-year survival was similar to USRDS (log-rank p = 0.94). Conclusions: In patients with Stage V CKD and asymptomatic CAD, renal transplant rates are low. Whether surgical revascularization offers survival benefit due to successful renal transplant or due to revascularization remains an area of future study. Longer follow-up, study of patient/procedural factors, and multidisciplinary efforts may improve patient selection and transplantation rates.