Combining Liver Transplantation With Heart Surgery an Option

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 Transplantation.

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 infection.

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.”