CORONARY-ARTERY BYPASS-GRAFTING IN PATIENTS WITH TRANSPLANTED LIVERS

Coronary artery bypass grafting was performed on 3 patients for refrac tory angina pectoris 48, 5, and 40 months after orthotopic Liver trans plantation. At the time of the cardiac operation, all 3 patients had d rug-induced moderate renal dysfunction, and 1 of the 3 exhibited mild chronic rejection of the graft. Maintenance immunosuppressive therapy was continued during the cardiac operation and the perioperative perio d. Stress-dose steroids and standard prophylactic antibiotics were als o employed. All 3 patients tolerated the cardiac surgical procedure wi thout hepatic decompensation, excessive bleeding, infection, impaired wound healing, and other complications related to the transplanted org an or to the immunosuppressive therapy. Early postoperative liver func tion test results showed mild transient deterioration. One patient exp erienced a brief psychotic episode and massive upper gastrointestinal bleeding. Both complications were attributed to the steroids used in i mmunosuppressive therapy. Follow-up ranging from 2 to 24 months after coronary artery bypass grafting revealed that the patients were active and had no cardiac symptoms or manifestations of hepatic decompensati on. If appears from this limited experience that cardiac operations ca n be performed safely in patients who have previously undergone liver transplantation.