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Updated: Nov 8, 2025
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Combined off pump coronary artery bypass graft and liver transplant
Rajiv Juneja1, Ajay Kumar2, Rajeev Ranjan1
1Institute of Critical Care and Anaesthesia, Medanta-the Medicity, Rishikesh, Uttarakhand, India.
Insights
Concomitant off-pump coronary artery bypass grafting (OPCAB) and living donor liver transplant (LDLT) in patients with end-stage liver disease reduces major adverse cardiovascular events. This combined approach offers acceptable outcomes for liver transplant recipients with cirrhosis.
Area of Science:
- Cardiology
- Hepatology
- Transplant Surgery
Background:
- Patients awaiting liver transplant (LT) often have coronary artery disease (CAD) requiring intervention.
- Performing LT before cardiac revascularization on cardiopulmonary bypass increases MACE risk in Child-Turcotte-Pugh (CTP) Class B/C patients.
- Isolated cardiac surgery before LT carries risks of coagulopathy, sepsis, and hepatic decompensation.
Purpose of the Study:
- To evaluate the safety and efficacy of simultaneous off-pump coronary artery bypass grafting (OPCAB) and living donor liver transplant (LDLT).
- To reduce morbidity and mortality in end-stage liver disease patients with CAD.
Main Methods:
- Four cases of end-stage liver disease with significant CAD underwent single-sitting OPCAB followed by LDLT.
- Morbidity parameters including intubation duration, blood transfusion, hospital/ICU stay, dialysis, atrial fibrillation, and sepsis were assessed.
- Outcomes were compared with historical data for combined on-pump CABG and LT.
Main Results:
- Lower incidence of atrial fibrillation (25%) and sepsis (25%) compared to on-pump procedures.
- Zero incidence of renal dysfunction and reduced blood transfusion requirements (median 8 PRBC units).
- Comparable median intubation time, ICU stay, hospital stay, and one-year mortality rates.
Conclusions:
- Combined OPCAB and LDLT demonstrates lower morbidity than on-pump CABG with LDLT.
- This combined approach is feasible and associated with acceptable outcomes in CTP Class B and C cirrhotic patients.
Background:
Prospective recipients of liver transplant (LT) have a high prevalence rate of coronary artery disease (CAD) requiring revascularization. In patients of Child Turcot Pugh Class B and C performing LT prior to cardiac revascularization on cardiopulmonary bypass leads to a high risk of major adverse cardiovascular events (MACE). Whereas, isolated cardiac surgery prior to LT has perioperative risk of coagulopathy, sepsis, and hepatic decompensation. We present four cases of end stage liver disease who underwent concomitant living donor liver transplant (LDLT) with off pump coronary artery bypass graft (OPCAB) in an effort to decrease the morbidity and mortality.
Methods:
The cases were performed in a tertiary care centre over two years. Four patients scheduled for LDLT, who were diagnosed with significant CAD, underwent single sitting OPCAB and LDLT. Cardiac surgery was performed first and once patient was stable, it was followed by LDLT. The morbidity parameters in terms of duration of intubation, blood transfusion, hospital stay, ICU stay, requirement of dialysis, atrial fibrillation and sepsis was compared with similar studies.
Results:
The blood transfusion requirement (median 8 units PRBC), incidence of atrial fibrillation (25%), sepsis (25%), and renal dysfunction (0%) was less than the combined surgery conducted on cardiopulmonary bypass. The rate of median intubation time, length of ICU stay, hospital stay, and one year mortality rate was comparable with other studies.
Conclusions:
Morbidity with combined OPCAB and LDLT is less than combined on pump coronary artery bypass surgery with LDLT. Combined CABG with LDLT may be performed with acceptable outcomes in CTP class B and C cirrhosis.
