The leading cause of death for people with renal insufficiency is cardiovascular disease. People with diabetes and especially those on dialysis are at higher risk for developing critical heart and vascular problems. Undergoing any operation, including a kidney transplant, can destabilize the heart’s function if the patient’s cardiac disease is not resolved before surgery.
“Existing cardiac and vascular problems must be addressed before transplant surgery,” stresses Gary J. Rogal, M.D., Chief of Cardiology, Saint Barnabas Health Care System (SBHCS). “The viability of the transplanted kidney depends on adequate blood pressure and good circulation.” Another strong argument for treating heart disease before transplantation is the fact that many of the substances used in the prevention or treatment of a heart attack, such as the contrast materials injected to perform an angiogram or catheterization, can be damaging to a freshly transplanted kidney, Dr Rogal points out. For these reasons, the SBHCS Renal and Pancreas Transplant Centers assess the cardiac risk of everyone seeking a kidney transplant.
The cardiac and renal transplant teams work closely together in identifying and resolving any heart disease that could prevent a successful transplant. “In some cases, the cardiac screening tests uncover serious heart problems that need to be addressed quickly, regardless of the patient’s desire for a kidney transplant,” says Dr. Rogal. “We have performed bypass surgery, valve repair and replacement, and cardiac catheterization on many patients who have then received cardiac clearance for renal transplantation.”
Augie DePreker, a transplant recipient who received a kidney donated by his wife, Thelma, in August 1999, underwent bypass surgery and experienced an episode of congestive heart failure several years before his transplant surgery.
After a heart attack in 1995, cardiac surgeons performed six bypasses circumventing the blocked arteries that had caused permanent damage to some portions of Mr. DePreker’s heart muscle. During his hospitalization, doctors discovered advancing renal disease. Mr. DePreker was able to postpone dialysis treatments for nearly four years, but, eventually, the fluid building up in his body due to his kidney failure put tremendous stress on his heart. Just days before the couple was to depart for an anniversary trip to the Bahamas, Mr. DePreker was hospitalized with congestive heart failure. He began dialysis immediately.
His health improved dramatically with dialysis, but the three evenings per week dedicated to the treatment were impacting the couple’s lifestyle, “and it would eventually have affected my career,” says Mr. DePreker, whose position as a superintendent of schools in a New Jersey school district requires that he participate in many evening business meetings.
The DePreker’s began exploring the possibility of a living donor kidney transplant. Before the transplant team would proceed with surgery, they requested that Mr. DePreker undergo a state-of-the-art nuclear stress test, an echocardiogram and a cardiac catheterization to completely assess the condition of his heart. “Dr. Mulgaonkar and the transplant nurse coordinator really advocated on my behalf,” says Mr. DePreker about the intense meeting he and his wife had with the team of physicians who would be involved in his care. “Dr. Mulgaonkar felt that despite the marginal damage to my heart, the team could perform a successful transplant with no undue risks for Thelma.”
Mr. DePreker’s heart was carefully monitored in the intensive care unit following surgery. “They took every precaution possible,” he remembers. After nearly a year since the transplant, Mr. DePreker’s kidney continues to function well. He has returned fully to his professional responsibilities and is back on the golf course, as well.
“Augie and I have returned completely to doing the things we love,” says Mrs. DePreker. “When I look back now on all that we went through, it seems like a dream.”
An area in which the SBHCS Renal and Pancreas Transplant Centers surpass other transplant programs nationwide is the post-transplant care and follow-up for patients with cardiac issues. SBHCS cardiologists have experience in managing cardiac issues intra-operatively and post-operatively in patients with cardiac disease who are cleared for the procedure. “The team is also vigilant in reassessing the cardiac status of kidney recipients for many years following transplantation,” notes Dr. Rogal.
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