Combining Liver Transplant With Bypass Surgery

A study of five patients who had liver transplantation combined with coronary artery bypass grafting (CABG) has shown the procedure to be safe and effective, with one-year mortality rates similar to those for a liver transplant alone.

Although liver transplantation has become a viable option for older patients, cardiovascular problems may prevent them from receiving a new liver. At the same time, some patients may safely undergo bypass surgery but experience a rapid decline in liver function during that procedure. To solve this problem, doctors performed bypass surgery combined with a liver transplant in five such patients. The procedure took about 14 hours. Researchers who studied the results concluded that the procedure is safe and effective for carefully selected patients.

All of the five patients had end-stage liver disease as well as three-vessel coronary artery disease with preserved left ventricular function. The cardiac surgery was performed first, except in patients with liver cancer (to ensure the cancer had not spread). All patients survived the surgery, but one died five months later from complications of hepatitis C infection. Other patients had complications that included pericardial effusion requiring re-operation, cardiac arrest, acute rejection, and pneumonia. Patient stays in intensive care ranged from two to 20 days. Factors that contributed to the positive results were careful donor selection, keeping the chest wound open during the liver transplant to inspect for hemostasis, and postoperative monitoring of patients by ultrasound.

"CABG-OLT [orthotopic liver transplantation] should be offered to patients with severe coronary artery disease who would otherwise be denied OLT due to their cardiac risk factors,” concluded the authors. The study was led by Alan Koffron, M.D., of Northwestern University (Evanston, IL, USA), and was published in the November 2004 issue of Liver Transplantation.


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