Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

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

08.11.2004


One-year mortality rates are comparable to those from liver transplantation alone



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.

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. The patients were evaluated by a team including surgery, hepatology, cardiology and anesthesiology before being listed for a transplant. When a liver became available, the patient was brought to the operating room. The cardiac surgery was performed first, except in patients with hepatocellular carcinoma (to ensure that the cancer had not spread,) then, the liver transplant. The combined procedure lasted an average of nearly 14 hours.

All of the patients survived the surgery, although one died five months later from complications of severe recurrent hepatitis C infection. Other patients experienced post-operative complications including pericardial effusion that required re-operation, cardiac arrest, acute rejection, and pneumonia. Patient stays in the intensive care unit ranged from 2 to 40 days (the mean was 10 days). Four of the five patients were discharged home while one patient required a brief in patient rehabilitation stay. "In this series," the authors report, "combined OLT-CABG appears to be a safe and effective approach to patients with severe coronary artery disease and end-stage liver disease." Several technical features of the combined procedure contributed to the positive results observed including careful donor selection, keeping the chest wound open during the liver transplant to inspect for hemostasis, and monitoring patients post-operatively using ultrasonography.

"The one-year mortality rates are comparable with OLT alone and, in general, ICU stay and hospital length of stay do not appear to be prolonged," the authors conclude. "CABG-OLT should be offered to patients with severe coronary artery disease who would otherwise be denied OLT due to their cardiac risk factors."

David Greenberg | EurekAlert!
Further information:
http://www.interscience.wiley.com/journal/livertransplantation
http://www.wiley.com

More articles from Health and Medicine:

nachricht A promising target for kidney fibrosis
21.04.2017 | Brigham and Women's Hospital

nachricht Stem cell transplants: activating signal paths may protect from graft-versus-host disease
20.04.2017 | Technische Universität München

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

Im Focus: Quantum-physical Model System

Computer-assisted methods aid Heidelberg physicists in reproducing experiment with ultracold atoms

Two researchers at Heidelberg University have developed a model system that enables a better understanding of the processes in a quantum-physical experiment...

Im Focus: Glacier bacteria’s contribution to carbon cycling

Glaciers might seem rather inhospitable environments. However, they are home to a diverse and vibrant microbial community. It’s becoming increasingly clear that they play a bigger role in the carbon cycle than previously thought.

A new study, now published in the journal Nature Geoscience, shows how microbial communities in melting glaciers contribute to the Earth’s carbon cycle, a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

7th International Conference on Crystalline Silicon Photovoltaics in Freiburg on April 3-5, 2017

03.04.2017 | Event News

 
Latest News

New quantum liquid crystals may play role in future of computers

21.04.2017 | Physics and Astronomy

A promising target for kidney fibrosis

21.04.2017 | Health and Medicine

Light rays from a supernova bent by the curvature of space-time around a galaxy

21.04.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>