Reuters Health Information (2004-11-25): Combining liver transplantation with heart surgery an option
Combining liver transplantation with heart surgery an option
Last Updated: 2004-11-25 7:45:27 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Coronary artery bypass
grafting (CABG) and orthotopic liver transplantation (OLT) performed in
a single operative procedure appears to be safe and effective in
patients with severe coronary artery disease and end-stage liver
disease, according to a look-back at the outcomes of five such
procedures performed at a single institution.
"The one-year mortality rates are comparable with OLT alone and, in
general, ICU stay and hospital length of stay do not appear to be
prolonged," Dr. David Axelrod and colleagues from Northwestern
University in Chicago report in the November issue of the journal Liver
The team notes that while severe coronary artery disease is common
in patients who require a liver transplant, CABG may trigger hepatic
decompensation. Thus, a combined procedure may be necessary.
The five patients who underwent combined CABG-OLT were between 54
and 66 years of age, four of them were male, and all had end-stage
liver disease as well as significant three-vessel coronary
atherosclerotic disease with preserved left ventricular function.
In the two patients without a diagnosis of cancer, CABG was
performed first, while in the three with hepatocellular carcinoma, OLT
was performed first to rule out the presence of metastatic disease. The
combined procedure took 14 hours on average.
There were no intraoperative deaths. One patient died 5 months after
CABG-OLT due to complications of severe recurrent hepatitis C
A mean of 25 months after the CABG-OLT procedure, graft and patient survival is 80%, the team reports.
They believe, based on their experience, that CABG-OLT "should be
offered to patients with severe coronary artery disease who would
otherwise be denied OLT due to their cardiac risk factors."
Liver Transpl 2004;10:1386-1390.