J Surg Res. 2026 Apr 13;321:662-672. doi: 10.1016/j.jss.2026.03.009. Online ahead of print.
ABSTRACT
INTRODUCTION: Severe coronary artery disease is often a barrier to kidney transplant (KT) evaluation. Coronary artery bypass graf (CABG) as a bridge to KT eligibility is not well studied. This analysis describes CABG postoperative outcomes and KT waitlist outcomes in this population from a single high-volume center.
METHODS: Patients from a single institution who received CABG for KT eligibility between August 2020 and May 2025 were retrospectively reviewed. Primary outcomes included all-cause mortality, occurrence of major adverse cardiovascular events, and incidence of subsequent KT.
RESULTS: Sixty patients received a CABG during KT evaluation with a median follow-up of 549 (interquartile range 244, 1039) d. Forty-five (75.0%) were males and the mean age was 59.6 (standard deviation [SD] 9.7) y. Patients were asymptomatic from coronary disease in 46 cases (76.7%) and the mean ejection fraction was 55.5% (SD 12.9). The mean Society of Thoracic Surgery score for predicted operative mortality was 2.9% (SD 2.6). All cause-mortality occurred in 2 (3.3%) at 30 d and 11 (18.3%) at 1 y. Postoperative major adverse cardiovascular events events at 1 y include stroke in 2 (3.3%), non-ST-elevation myocardial infarction in 7 (11.9%), and percutaneous coronary intervention in 4 (6.7%). Event-free 1-y survival was 69.3% (confidence interval 58.1-82.7). Ultimately, 11 (18.3%) received KT with the median time from CABG to KT of 564 d (interquartile range 404, 725).
CONCLUSIONS: Despite considerable 30-d and 1-y mortality, a subset of patients undergoing CABG as a bridge to KT is ultimately able to receive KT following CABG. Further research is required to individualize preoperative decision-making.
PMID:41980490 | DOI:10.1016/j.jss.2026.03.009