Concomitant vs staged orthotopic liver transplant after cardiac surgical procedures

In patients who require orthotopic liver transplant (OLT), cardiac surgery may be needed to optimize preoperative cardiac status for OLT. The aim of this systematic review was to evaluate patient characteristics and outcomes of those undergoing staged versus concomitant cardiac procedures with OLT.

An electronic search was performed to identify all case reports and series, from which patient-level data was extracted regarding cardiac procedures associated with OLT. After assessment for inclusion and exclusion criteria, 26 articles were pooled for systematic review.

Overall, 49 patients were included in the analysis, of whom 12 (24%) underwent staged procedures and 37 (76%) underwent concomitant procedures. The median age was lower in the staged group [staged: 51 (IQR, 43.8-59.2) years vs. concomitant: 60 (IQR, 55.0-64.0) years, p = .02]. Other baseline characteristics were comparable between the two groups. For staged procedures, the median time between heart procedures and OLT was 2 (IQR, 1.0-3.5) months. The most commonly reported cardiac procedures were coronary artery bypass graft (CABG) [staged: 4/12 (33.3%) vs. concomitant: 21/37 (56.8%), p = .28], aortic valve replacement (AVR) [staged: 3/12 (25.0%) vs. concomitant: 19/37 (51.2%), p = .21], and transcatheter aortic valve replacement (TAVR) [staged: 4/12 (33.3%) vs. concomitant: 0/37 (0%), p = .002]. Regarding outcomes, there was a significantly shorter post-OLT hospital stay for those who had staged procedures versus those who had concomitant procedures [staged: 8 (IQR, 5-13) days vs. concomitant: 17 (IQR, 14-24) days, p = .007]. However, both groups had similar in-hospital mortality rates [staged: 1/12 (8.3%) vs. concomitant: 4/37 (10.8%), p = 1.0]. Overall survival stratified between the two groups was comparable.

Patients who underwent the staged approach had a shorter post-transplant hospital stay, but comparable survival with respect to those who underwent concomitant cardiac procedures and OLT.