The Safety of Cardiac Operations in the Liver Transplant Recipient

Prabhakar, Ganga; Testa, Giuliano; Abbasoğlu, Osman; Jeyarajah, D. Rohan; Goldstein, Robert M.; Levy, Marlon F.; Husberg, Bo S.; Gonwa, Thomas A.; Klintmalm, Göran B.

doi:10.1016/s0003-4975(98)00094-0

Cited by 33 publications

(34 citation statements)

References 8 publications

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“…This is in contrast to other studies where the perioperative mortality varied from 1.4 [2], 2 [23], 3 [16], 5 [15] and 8.8 [21] to 14% [1]. However, Prabhakar's group [14] has also reported no early mortality. We ascribe this to be the result of close cooperation between the cardiac surgical teams, the renal and hepatic transplant physicians, the anaesthetists and the intensivists, who are available round the clock because of the excellent logistics of a tertiary-care hospital facility.…”

Section: Original Articlecontrasting

confidence: 80%

“…This finding has allowed us to deduce that daily renal and liver functions are not required unless the immediate postoperative functions are extremely disturbed or otherwise clinically indicated. A similar opinion has been published by others [14]. The immunosuppression was continued even in failed transplant patients on the premise that it will prevent acute rejection-a process that is still possible, despite failed allograft.…”

Section: Original Articlementioning

confidence: 52%

“…It is interesting to note that there was no early or late mortality in the liver transplant patients. No early mortality in liver transplant patients has also been reported by Prabhakar et al [14], but late survival has only been reported to be 69 ± 13% by Deb et al [23].…”

Section: Original Articlementioning

confidence: 86%

“…Some of the groups have restricted the study to only valves [17] or only CABG [18,19]. However, most groups have studied the combined population of CABG and valve patients [13][14][15][16][20][21][22][23]. In our series, there was no perioperative mortality in either of the groups.…”

Section: Original Articlementioning

confidence: 91%

“…Most reports have concentrated on renal transplant patients [13], while others have considered only liver transplants [14] and some have included pancreatic transplants as well [2,15]. Our study investigated both liver and kidney transplant patients.…”

Section: Original Articlementioning

confidence: 99%

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Cardiac Surgical Outcomes in Abdominal Solid Organ (Renal and Hepatic) Transplant Recipients: A Case Matched Study

Sharma

Hawley

Griffin

et al. 2011

Heart, Lung and Circulation

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OBJECTIVES: This study aims to investigate the outcomes of cardiac surgery in patients with abdominal solid organ transplants and to compare them with the case-matched population undergoing cardiac surgery. METHODS:Data from all transplant recipients abdominal solid organ transplant (ASOT) N = 36 (30 renal and 6 hepatic) who underwent cardiac surgery in a single centre during the period from January 1997 to December 2010 were collected from hospital transplant registries and the cardiac database. The transplant recipients were case matched (CM) with 104 patients in terms of the variables of age, sex and the type of cardiac surgery. Follow-up data were obtained from medical records and by a set of questionnaire through telephonic interviews.RESULTS: Follow-up times were 4.5 ± 3.2 and 3.9 ± 3.2 years in the transplant and CM groups, respectively. Follow-up in the transplant group was 100%. There was no 30-day mortality in the transplant group. Thirty-day combined major morbidities were 9% in the matched group vs 11% in the transplant patients (P = 0.6). Median length of stay was 6 days (inter-quartile range, IQR 5.9) for ASOT vs 5 days (IQR 4.6) for CM (P < 0.01). New dialysis was 8.3% in transplant patients compared with 0.96% in the matched population, while infection was 16.66 vs 0.42% in the CM cohort. There was no allograft failure/dysfunction at the time of death or latest follow-up. Late deaths were 8 of 36 (22%) in ASOT vs 6 of 104 (6%) in CM. Infection (63%) was the most frequent major cause of death in transplant patients. One-, 2-, 5-and 10-year survivals for ASOT vs CM were 94, 88, 80, 59 vs 99, 99, 91, 85%, respectively. Multivariate predictors of mortality were increasing age (hazard ratio, HR 1.1, 95% confidence interval, CI 1.04-1.18; P = 0.003) and solid organ transplantation (HR 3.44, CI 1.19-9.98; P = 0.023).CONCLUSIONS: Cardiac surgery can be performed in patients with abdominal solid organ tranpslant recipients with acceptable early morbidity and mortality. However, long-term survival in transplant patients is poor. Infection remains the most common cause of death.

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Section: Original Articlecontrasting

confidence: 80%

Section: Original Articlementioning

confidence: 52%

Section: Original Articlementioning

confidence: 86%

Section: Original Articlementioning

confidence: 91%

Section: Original Articlementioning

confidence: 99%

See 3 more Smart Citations

Cardiac Surgical Outcomes in Abdominal Solid Organ (Renal and Hepatic) Transplant Recipients: A Case Matched Study

Sharma

Hawley

Griffin

et al. 2011

Heart, Lung and Circulation

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Safety and efficacy of combined orthotopic liver transplantation and coronary artery bypass grafting

et al. 2004

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Advanced coronary artery disease (CAD) is increasingly common in patients awaiting orthotopic liver transplantation (OLT). Unfortunately, in patients whose coronary artery anatomy is not amenable to angioplasty, coronary artery bypass grafting (CABG) alone may precipitate hepatic decompensation. Thus, combined liver transplant and coronary artery bypass grafting (CABG-OLT) may be required to effectively treat both conditions. Clinical records were analyzed for 5 CABG-OLT procedures at a single institution. Operative indications, technical details, and postoperative course were determined for each patient. Patients undergoing CABG-OLT had a mean age of 57.8 years (range, 54-66) and were predominantly male (80%). All patients had significant 3-vessel coronary atherosclerotic disease with preserved left ventricular function. There were no intraoperative deaths. At mean 25 months of follow-up (range, 8.0-25) there was an 80% graft and patient survival. Overall average length of stay was 21 days (range, 7-59 days). In conclusion, CABG-OLT procedure appears to be safe and effective in the population of patients with advanced CAD and liver disease. In this series, patients appear to benefit from multidisciplinary preoperative evaluation, coordination between cardiac and transplant surgeons, careful graft selection, and use of sapheno-atrial veno-veno bypass.

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Excellent results of cardiac surgery in patients with previous liver transplantation

Filsoufi¹,

Rahmanian²,

Castillo³

et al. 2007

Liver Transpl

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Cardiovascular diseases requiring surgical therapy in patients with prior liver transplantation are rare. Little is known about the outcome of patients with liver allograft undergoing cardiac surgery. Herein we report our experience in this patient population with an emphasis on operative outcomes and mid-term survival. Between January 1998 and December 2004, 12 patients (mean Ϯ standard deviation age 68 Ϯ 9 years, 7 [58%] male) with previous liver transplantation who underwent cardiac surgery were identified. Main outcome measures were hospital mortality, postoperative complications, allograft function, and long-term survival. There was no in-hospital mortality. Three major complications (25%) occurred, including 1 each (8%) of respiratory failure, renal failure, and biliary leakage. All complications were resolved by the time of discharge. Allograft dysfunction determined by an increase of liver function parameters was noticed in 4 (33%) and recovered before discharge. The average length of stay in intensive care unit was 72 Ϯ 45 hours, and the mean length of stay in hospital was 22 Ϯ 17 days. One-and 5-year survival was 91% Ϯ 8% and 67% Ϯ 14%, respectively. Cardiac surgery can be performed safely in liver transplant recipients with extremely low mortality and acceptable morbidities. Allograft dysfunction is a common finding, but it is transient, with early functional recovery. Five-year survival of liver recipients undergoing cardiac procedures is similar to that of the general population undergoing cardiac surgery. Our data suggest that these patients should be considered for cardiac surgery in reference centers with expertise in complex cardiac procedures and perioperative management of these highly specific patients. Liver Transpl 13:1317Transpl 13: -1323Transpl 13: , 2007

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The Safety of Cardiac Operations in the Liver Transplant Recipient

Cited by 33 publications

References 8 publications

Cardiac Surgical Outcomes in Abdominal Solid Organ (Renal and Hepatic) Transplant Recipients: A Case Matched Study

Cardiac Surgical Outcomes in Abdominal Solid Organ (Renal and Hepatic) Transplant Recipients: A Case Matched Study

Safety and efficacy of combined orthotopic liver transplantation and coronary artery bypass grafting

Excellent results of cardiac surgery in patients with previous liver transplantation

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