Pretransplant coronary artery disease associated with worse clinical outcomes in pancreas transplantation

Background Coronary artery disease ( CAD ) is common in patients with type I diabetes and may be associated with worse outcomes in patients undergoing pancreas transplantation ( PT ). This study evaluates PT patients to determine the pre transplant prevalence of CAD and assesses the post‐transplant outcomes including complications and survival. Methods This study is a retrospective review of PT s from 2003 to 2011. Diagnosis of CAD required cardiac catheterization. Outcomes included: myocardial infarction ( MI ), stroke, and survival. Results There were 405 transplants in 389 patients with median follow‐up of 56 months. Pre transplant prevalence of CAD was 19% (n = 74). There was no increased risk of perioperative, 90‐d or one‐yr mortality for patients with CAD . The CAD group did have increased risk of MI (11% vs. 1%, p < 0.001) and stroke (8% vs. 3%, p = 0.02). Controlling for patient and donor age, and history of CAD , the CAD group had decreased patient survival at five yr (82% vs. 90%, p = 0.09, HR 1.77) by Cox regression. Conclusions Patients with type I diabetes and CAD have increased risk of MI and stroke post‐pancreas transplant, with decreased five‐yr survival. Patients without CAD and a negative pre transplant cardiac evaluation carry a low risk of post‐transplant MI .