Follow-up after coronary revascularisation in patients with renal transplants.

Seven patients underwent coronary revascularisation 12-145 months (mean: 63.4 months) after receiving cadaver renal transplants. There was no operative mortality and in all patients satisfactory renal function was maintained perioperatively. Hospital stay ranged from 7 days to 10 days (mean: 8 days). During the period of follow-up (5-72 months, mean: 35 months): one patient remained angina-free at 7 months postoperatively; one patient developed meningitis with Listeria monocytogenes 9 weeks after surgery, and died of streptococcal septicaemia 11 weeks later. The other five patients (71.4%) developed recurrence of angina requiring antianginal therapy, and three of them sustained myocardial infarctions. Three patients developed intermittent claudication, two of whom sustained acute leg ischaemia. Two patients developed heart failure, one of whom died 38 months postoperatively. In four patients who were restudied with cardiac catheterisation and coronary angiography (2-17 months postoperatively) there was evidence of progression of the coronary arterial disease in three, although all coronary grafts were patent. Renal function remained satisfactory in 5 patients, and deteriorated in two patients; in one secondary to advanced heart failure; and in one as a terminal event secondary to septicaemia. Although patients with renal transplants can safely undergo open cardiac procedures, the long-term results of coronary surgery are adversely affected by the progressive disease from which they suffer.