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 Laser activated gold pyramids could deliver drugs, DNA into cells without harm
24.03.2017 | Harvard John A. Paulson School of Engineering and Applied Sciences

nachricht What does congenital Zika syndrome look like?
24.03.2017 | University of California - San Diego

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: Giant Magnetic Fields in the Universe

Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.

The results will be published on March 22 in the journal „Astronomy & Astrophysics“.

Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...

Im Focus: Tracing down linear ubiquitination

Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.

Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...

Im Focus: Perovskite edges can be tuned for optoelectronic performance

Layered 2D material improves efficiency for solar cells and LEDs

In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...

Im Focus: Polymer-coated silicon nanosheets as alternative to graphene: A perfect team for nanoelectronics

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.

Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...

Im Focus: Researchers Imitate Molecular Crowding in Cells

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to simulate these confined natural conditions in artificial vesicles for the first time. As reported in the academic journal Small, the results are offering better insight into the development of nanoreactors and artificial organelles.

Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

International Land Use Symposium ILUS 2017: Call for Abstracts and Registration open

20.03.2017 | Event News

CONNECT 2017: International congress on connective tissue

14.03.2017 | Event News

ICTM Conference: Turbine Construction between Big Data and Additive Manufacturing

07.03.2017 | Event News

 
Latest News

Argon is not the 'dope' for metallic hydrogen

24.03.2017 | Materials Sciences

Astronomers find unexpected, dust-obscured star formation in distant galaxy

24.03.2017 | Physics and Astronomy

Gravitational wave kicks monster black hole out of galactic core

24.03.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>