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 Indications of Psychosis Appear in Cortical Folding
26.04.2018 | Universität Basel

nachricht GLUT5 fluorescent probe fingerprints cancer cells
20.04.2018 | Michigan Technological University

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: Why we need erasable MRI scans

New technology could allow an MRI contrast agent to 'blink off,' helping doctors diagnose disease

Magnetic resonance imaging, or MRI, is a widely used medical tool for taking pictures of the insides of our body. One way to make MRI scans easier to read is...

Im Focus: BAM@Hannover Messe: innovative 3D printing method for space flight

At the Hannover Messe 2018, the Bundesanstalt für Materialforschung und-prüfung (BAM) will show how, in the future, astronauts could produce their own tools or spare parts in zero gravity using 3D printing. This will reduce, weight and transport costs for space missions. Visitors can experience the innovative additive manufacturing process live at the fair.

Powder-based additive manufacturing in zero gravity is the name of the project in which a component is produced by applying metallic powder layers and then...

Im Focus: Molecules Brilliantly Illuminated

Physicists at the Laboratory for Attosecond Physics, which is jointly run by Ludwig-Maximilians-Universität and the Max Planck Institute of Quantum Optics, have developed a high-power laser system that generates ultrashort pulses of light covering a large share of the mid-infrared spectrum. The researchers envisage a wide range of applications for the technology – in the early diagnosis of cancer, for instance.

Molecules are the building blocks of life. Like all other organisms, we are made of them. They control our biorhythm, and they can also reflect our state of...

Im Focus: Spider silk key to new bone-fixing composite

University of Connecticut researchers have created a biodegradable composite made of silk fibers that can be used to repair broken load-bearing bones without the complications sometimes presented by other materials.

Repairing major load-bearing bones such as those in the leg can be a long and uncomfortable process.

Im Focus: Writing and deleting magnets with lasers

Study published in the journal ACS Applied Materials & Interfaces is the outcome of an international effort that included teams from Dresden and Berlin in Germany, and the US.

Scientists at the Helmholtz-Zentrum Dresden-Rossendorf (HZDR) together with colleagues from the Helmholtz-Zentrum Berlin (HZB) and the University of Virginia...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Invitation to the upcoming "Current Topics in Bioinformatics: Big Data in Genomics and Medicine"

13.04.2018 | Event News

Unique scope of UV LED technologies and applications presented in Berlin: ICULTA-2018

12.04.2018 | Event News

IWOLIA: A conference bringing together German Industrie 4.0 and French Industrie du Futur

09.04.2018 | Event News

 
Latest News

World's smallest optical implantable biodevice

26.04.2018 | Power and Electrical Engineering

Molecular evolution: How the building blocks of life may form in space

26.04.2018 | Life Sciences

First Li-Fi-product with technology from Fraunhofer HHI launched in Japan

26.04.2018 | Power and Electrical Engineering

VideoLinks
Science & Research
Overview of more VideoLinks >>>