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Combined Cardiothoracic Surgery and Liver Transplantation Versus Isolated Liver Transplantation
Christine C Myo Bui1, Colby Tanner1, Christine Nguyen-Buckley1
1Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Journal of Cardiothoracic and Vascular Anesthesia
|September 21, 2020
Summary
Combined cardiothoracic surgery and liver transplantation (cCSLT) shows promising results. Patients undergoing cCSLT had similar 90-day survival rates compared to isolated liver transplantation (iLT), despite complex procedures.
Area of Science:
- Transplant Surgery
- Cardiothoracic Surgery
- Hepatology
Background:
- Combined cardiothoracic surgery and liver transplantation (cCSLT) is increasingly utilized.
- The perioperative management and outcomes of cCSLT are not well-characterized.
- This study compares cCSLT with isolated liver transplantation (iLT).
Purpose of the Study:
- To compare perioperative management between cCSLT and iLT patients.
- To evaluate postoperative outcomes for cCSLT versus iLT.
Main Methods:
- Retrospective study at a university tertiary medical center.
- Compared 25 cCSLT patients with 100 randomly selected and 100 propensity-matched iLT patients (2010-2017).
- Comprehensive preoperative evaluation by a multidisciplinary team.
Main Results:
- Common cardiothoracic surgeries included heart, coronary artery bypass grafting, and lung transplants.
- cCSLT patients required more interventions like cardiopulmonary bypass and massive transfusions.
- Ninety-day survival rates were comparable: 100% for cCSLT vs. 87-93% for iLT (p=0.089).
Conclusions:
- cCSLT patients with advanced cardiothoracic and liver disease achieve comparable 90-day survival to iLT patients.
- Success in cCSLT hinges on comprehensive pre-transplant planning, patient/donor selection, and meticulous intraoperative management.
- A multidisciplinary, multi-team approach is critical for successful cCSLT.
