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Published on: August 17, 2022
Cardiac Intervention Before Liver Transplantation
Ashraf Imam1, Cihan Karatas1, Nesimi Mecit1
1Liver Transplantation Department, Koc University Hospital, Istanbul, Turkey.
Insights
Coronary artery bypass grafting (CABG) is a safe option for patients with coronary artery disease awaiting liver transplantation (LT). This study found no mortality in patients who underwent CABG before LT.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Surgery
Background:
- Cardiovascular complications are a leading cause of mortality post-liver transplantation (LT).
- Pre-transplant cardiac evaluation is crucial for patients undergoing LT.
- Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are treatments for coronary artery disease.
Purpose of the Study:
- To evaluate the safety and efficacy of cardiac interventions prior to LT.
- To assess CABG as a treatment option for patients with coronary artery disease and end-stage liver disease.
Main Methods:
- Retrospective, single-center study.
- Included patients who underwent cardiac intervention (PCI or CABG) before LT for end-stage liver disease.
- Data collected on patient demographics, procedures, and outcomes.
Main Results:
- 29 of 51 patients had cardiac intervention before LT.
- 24 patients had diagnostic PCI, 3 had therapeutic PCI with stent, and 2 had PCI failure requiring CABG.
- The 2 CABG patients underwent live-related LT with no reported mortality.
Conclusions:
- CABG is a valuable and safe treatment for cirrhotic patients with coronary artery disease awaiting LT, especially after PCI failure.
- Live donor LT can serve as a backup for patients experiencing hepatic decompensation.
Background:
Cardiovascular complication is one of the leading causes of mortality after liver transplantation (LT). Thus, a thorough cardiac evaluation is a must before proceeding to a liver transplant surgery. Percutaneous coronary intervention (PCI) with stent and to a lesser extent coronary artery bypass grafting (CABG) are both valuable treatment options for patients with coronary artery disease.
Methods:
A retrospective, single-center study that included patients who underwent cardiac intervention and subsequent LT for end-stage liver disease. All patients who had PCI or CABG were included in the study.
Results:
Twenty-nine adult patients out of 51 had a cardiac intervention before liver transplantation. Twenty-four patients had a diagnostic PCI, 3 patients had therapeutic PCI with stent, and 2 had failed PCI and proceeded to CABG before liver transplant. The mean age of the patients was 60.5 years. There were 24 men. All patients had cirrhosis. The 2 CABG cases were done during the same admission with a 13- and 18-day interval between the CABG and the transplantation. Both cases were live-related liver transplantation. No mortality was reported.
Conclusion:
In case of PCI failure, CABG may be a valuable and safe treatment option for cirrhotic patients as a preparation for liver transplantation. Live donor liver transplantation may be a good back-up for those patients in case they develop hepatic decompensation.
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