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Combined Living Donor Liver Transplantation With Coronary Artery Bypass Grafting: Possible but not Without a Struggle
Vijay Vohra1, Pooja Bhangui1, Prashant Bhangui2
1Department of Liver Transplant and GI Anaesthesia, Medanta - The Medicity, Sector 38, Gurgaon, 122001, India.
Insights
Combined liver transplant and coronary artery bypass grafting is feasible for patients with cirrhosis and coronary artery disease. Careful planning and multidisciplinary management are crucial for optimal outcomes in this complex procedure.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Surgery
Background:
- Combined liver transplant (LT) and coronary artery bypass grafting (CABG) is sometimes necessary for patients with decompensated cirrhosis and significant coronary artery disease (CAD).
- This combined procedure carries substantial risks of morbidity and mortality.
Purpose of the Study:
- To evaluate the feasibility and outcomes of combined off-pump CABG (OPCAB) and living donor liver transplantation (LDLT).
Main Methods:
- Eight patients with CAD underwent combined OPCAB and LDLT between May 2012 and August 2020.
- Analysis included patient demographics, preoperative findings, operative details, and postoperative outcomes.
Main Results:
- The mean recipient age was 59 years, with a Model for End-Stage Liver Disease (MELD) score of 20.
- Mean surgery duration was 982 minutes; median ICU and hospital stays were 8 and 18 days, respectively.
- Two patients died postoperatively from sepsis with multiorgan failure; four developed manageable atrial arrhythmias.
Conclusions:
- Combined CABG and LDLT is feasible but challenging, requiring meticulous pre- and post-operative management.
- A multidisciplinary team approach is essential for optimizing outcomes in these high-risk patients.
Background:
A combined liver transplant (LT) and coronary artery bypass grafting (CABG) may sometimes be needed for patients with decompensated cirrhosis who also have significant coronary artery disease (CAD). However, such a procedure is associated with significant morbidity and mortality.
Methods:
From May 2012 to August 2020, eight patients with significant coronary artery disease (CAD) underwent combined off pump CABG (OPCAB) and living donor liver transplantation (LDLT) at our center. We analyzed patient demographics, preoperative clinical findings, operative details, and postoperative outcomes.
Results:
Mean recipient age and body mass index were 59 ± 6 years and 26 ± 3kg/m2, respectively. The model for end-stage liver disease (MELD) score was 20. Four patients each had hypertension and diabetes. Mean total duration of the surgery was 982 ± 117 min, with 598 ± 89 min for living donor liver transplantation (LDLT). The mean volume of packed red blood cell transfusion was 2500ml. The duration of the ventilatory support (median 49 h post-surgery), and the median intensive care unit and hospital stay (8 and 18 days, respectively). Two patients died during the postoperative period due to sepsis with multiorgan failure No recipient had evidence of acute coronary syndrome, stress cardiomyopathy; none required interventional hemodynamic support. Four patients developed atrial arrhythmia's in the post-operative period, all were managed successfully with medical management.
Conclusion:
Combined CABG and LDLT is feasible but poses significant challenges. Careful preprocedure planning, and meticulous intra- and post-operative management involving a multidisciplinary team of LT Surgeons and anesthetists, hepatologists, cardiologists, and cardiac surgeons is required to ensure optimal outcomes in these patients.
