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Combining liver transplantation and coronary artery bypass grafting can be safe and effective

Improvements in surgical techniques have made orthotopic liver transplantation (OLT) a viable option for older patients who may also have cardiovascular disease, but poor cardiovascular health may keep transplant candidates from receiving a new organ.

Some such patients can safely undergo angioplasty to correct their heart conditions first, however, those requiring coronary artery bypass grafting (CABG) can experience a rapid decline in liver function during the procedure. To address this dilemma, in rare instances, doctors have performed CABG in conjunction with OLT.

Researchers led by Alan Koffron, M.D. of Northwestern University, recently studied five patients' experiences with this combined procedure and concluded it can be both safe and effective, with one-year mortality rates similar to those reported for liver transplantation alone. The authors suggest that patients receiving CABG-OLT benefit from multidisciplinary preoperative evaluation, coordination between cardiac and transplant surgeons, careful graft selection, and use of sapheno-atrial veno-veno bypass.

Their findings are published in the November 2004 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS). The journal is published on behalf of the societies by John Wiley & Sons, Inc., and is available online via Wiley InterScience (http://www.interscience.wiley.com/journal/livertransplantation).

The researchers retrospectively reviewed the medical records of five patients who underwent combined CABG-OLT. They ranged in age from 54 to 66 years old and four of the five patients were male. All of the patients had end-stage liver disease, as well as significant three vessel coronary atherosclerotic disease with preserved left ventricular function.

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Contact: David Greenberg
dgreenbe@wiley.com
John Wiley & Sons, Inc.
5-Nov-2004


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