Coronary artery bypass and liver transplantation can be safely combined in a single operation, according to a look-back at the outcomes of five such procedures performed at one institution.

Surgeons reporting these results explain that severe coronary artery disease is common in patients who require a liver transplant, but coronary bypass surgery may trigger complete liver failure. Thus, a simultaneous procedure may be necessary.

The mortality rate after the double operation are in line with that seen with liver transplantation alone “and, in general, ICU stay and hospital length of stay do not appear to be prolonged,” Dr. David Axelrod and colleagues from Northwestern University in Chicago report in the medical journal Liver Transplantation.

The five patients who underwent combined coronary bypass and liver transplantation were between 54 and 66 years of age, four of them were men, and all had end-stage liver disease as well as advanced coronary disease.

In the two patients without cancer, coronary bypass grafting was performed first, while in the three with liver cancer, the liver transplant was performed first to make sure the cancer had not spread. The combined procedure took 14 hours on average.

There were no deaths on the operating table. One patient did die 5 months after surgery due to complications of severe recurrent hepatitis C infection.

The remaining four patients - and their new livers - are doing well an average of 25 months after the double procedure, the team reports.

They believe that simultaneous coronary bypass and liver transplantation “should be offered to patients with severe coronary artery disease who would otherwise be denied (a liver transplant) due to their cardiac risk factors.”

SOURCE: Liver Transplantation, November 2004.