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Updated: Jul 12, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Excellent results of cardiac surgery in patients with previous liver transplantation
Farzan Filsoufi1, Parwis B Rahmanian, Javier G Castillo
1Department of Cardiothoracic Surgery, Division of Liver Disease, Mount Sinai School of Medicine, New York, NY 10029-1028, USA. farzan.filsoufi@mountsinai.org
Insights
Cardiac surgery is safe for liver transplant recipients, showing no in-hospital deaths and good long-term survival. Transient allograft dysfunction is common but resolves, indicating successful outcomes in specialized centers.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Surgery
Background:
- Cardiovascular diseases requiring surgery in liver transplant recipients are uncommon.
- Limited data exists on the outcomes of cardiac surgery in patients with liver allografts.
Purpose of the Study:
- To evaluate operative outcomes and mid-term survival in liver transplant recipients undergoing cardiac surgery.
- To assess the safety and efficacy of cardiac procedures in this unique patient population.
Main Methods:
- Retrospective review of 12 liver transplant recipients who underwent cardiac surgery between 1998 and 2004.
- Analysis of hospital mortality, postoperative complications, allograft function, and survival rates.
Main Results:
- No in-hospital mortality was observed.
- 25% experienced major complications (respiratory failure, renal failure, biliary leakage), all resolved by discharge.
- 33% showed transient allograft dysfunction, which recovered before discharge.
- One- and 5-year survival rates were 91% and 67%, respectively.
Conclusions:
- Cardiac surgery can be performed safely in liver transplant recipients with low mortality and manageable morbidities.
- Allograft dysfunction is typically transient, with early functional recovery.
- Five-year survival is comparable to the general population undergoing cardiac surgery, supporting consideration for these procedures in expert centers.
Abstract:
Cardiovascular diseases requiring surgical therapy in patients with prior liver transplantation are rare. Little is known about the outcome of patients with liver allograft undergoing cardiac surgery. Herein we report our experience in this patient population with an emphasis on operative outcomes and mid-term survival. Between January 1998 and December 2004, 12 patients (mean +/- standard deviation age 68 +/- 9 years, 7 [58%] male) with previous liver transplantation who underwent cardiac surgery were identified. Main outcome measures were hospital mortality, postoperative complications, allograft function, and long-term survival. There was no in-hospital mortality. Three major complications (25%) occurred, including 1 each (8%) of respiratory failure, renal failure, and biliary leakage. All complications were resolved by the time of discharge. Allograft dysfunction determined by an increase of liver function parameters was noticed in 4 (33%) and recovered before discharge. The average length of stay in intensive care unit was 72 +/- 45 hours, and the mean length of stay in hospital was 22 +/- 17 days. One- and 5-year survival was 91% +/- 8% and 67% +/- 14%, respectively. Cardiac surgery can be performed safely in liver transplant recipients with extremely low mortality and acceptable morbidities. Allograft dysfunction is a common finding, but it is transient, with early functional recovery. Five-year survival of liver recipients undergoing cardiac procedures is similar to that of the general population undergoing cardiac surgery. Our data suggest that these patients should be considered for cardiac surgery in reference centers with expertise in complex cardiac procedures and perioperative management of these highly specific patients.
