Dr Zena Barakat1, Dominic Keuskamp2,3, Christopher E Davies2,3, Robert A Baker4,5, Kevan R Polkinghorne1,6, Christopher M Reid6,7, Julian A Smith8,9, Lavinia Tran6, Jenni Williams Spence6, Rory Wolfe6, Stephen P McDonald2,3,10
1Department of Nephrology, Monash Health, Clayton, Australia, 2Australia & New Zealand Dialysis & Transplant Registry, South Australian Health & Medical Research Institute, Adelaide, Australia, 3Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia, 4College of Medicine & Public Health, Flinders University, Bedford Park, Australia, 5Cardiac Surgery Quality & Outcomes Department, Flinders Medical Centre, Bedford Park, Australia, 6School of Public Health & Preventive Medicine, Monash University, Clayton, Australia , 7School of Population Health, Curtin University, Bentley, Australia, 8Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Clayton, Australia, 9Department of Cardiothoracic Surgery, Monash Health, Clayton, Australia, 10Central & Northern Adelaide Renal & Transplantation Services, Royal Adelaide Hospital, Adelaide, Australia
Biography:
Zena Barakat is a final-year advanced trainee in nephrology with a strong interest in epidemiology and renal research.
Aim:
To estimate the incidence of waitlisting and kidney transplantation following coronary artery bypass grafting (CABG) and describe associations with dialysis modality.
Background:
Cardiovascular complications are a leading cause of mortality in kidney transplant patients. Assessing cardiac risk is crucial for transplant candidate selection and improving outcomes. Although revascularisation with CABG may be part of the pre-transplant process, it carries a high risk of morbidity and mortality. Waitlisting and transplantation outcomes for this cohort are poorly understood.
Methods:
Data were probabilistically linked between the Australia & New Zealand Dialysis & Transplant Registry and the Australian & New Zealand Society of Cardiac & Thoracic Surgeons Cardiac Surgery Database. Adults (≥18 years) who commenced long-term dialysis within two years prior to undergoing CABG between 2001 and 2019 were included (n=352). Competing risks of waitlisting, living donor transplant, and mortality were estimated using time-to-event analysis, stratified by dialysis modality and pre-operative comorbidities. Follow-up continued until the end of 2019.
Results:
Among the 352 patients who underwent surgery, 98 (28%) were waitlisted, 5 (1%) received a living donor transplant, and 116 (33%) died before either outcome, during a median follow-up time of 1.7 years [IQR 0.8-3.6]. Most (86%) had no prior percutaneous coronary intervention. The two-year cumulative incidence of waitlisting and transplantation was 28.0% (95% CI: 23.1-33.8) and 16.2% (12.3-21.1), respectively. Patients on home-based haemodialysis or peritoneal dialysis had higher rates of waitlisting (47.5% [19.6-85.0]) and transplantation (24.1% [15.6-26.1]) compared to facility dialysis (22.9% [17.6-29.4] and 12.8% [8.8-18.2], respectively).
Conclusions:
Dialysis patients undergoing CABG experienced high early mortality and low rates of transplant access. However, home-based dialysis modalities were associated with significantly improved waitlisting and transplantation.