THE SAFETY OF CARDIAC OPERATIONS IN THE LIVER-TRANSPLANT RECIPIENT

Background. Advances in surgical techniques and immunosuppressive drug s have improved the survival of patients after orthotopic liver transp lantation. Enhanced survival has resulted in an increased number of pa tients who require medical as well as surgical managment of diseases. Methods. To contribute to the sparse literature on the surgical aspect s, we reviewed our experience with 15 patients who underwent cardiac o peration (1.25%) from a total of 1,200 liver transplant recipients at our center. The variables studied included the pretransplant cardiac e valuation, the interval from transplantation to cardiac operation, pos toperative complications, the management of immunosuppression, and fol low-up. The patients had a mean age of 52.9 years (range, 39 to 69 yea rs) and 13 of them (86.6%) were men. Multiple cardiac risk factors wer e present in all 15 patients and chronic renal insufficiency was prese nt in 7 patients. Cardiac operation was undertaken a mean of 30.4 mont hs (range, 9 days to 62 months) after myocardial ischemia and valvular regurgitation had been ruled out at the time of transplantation. Myoc ardial revascularization was performed in 12 patients, 2 of whom under went concurrent valve operation and 3 of whom underwent valve repair o r replacement. Most patients had their immunosuppression regimen conti nued at baseline levels. Results. There were no early deaths. Three pa tients had major complications and 4 had minor complications. There we re no bleeding, infection, or healing complications. Postoperative ren al parameters were persistently elevated in 5 patients and transiently elevated in 3. Liver function parameters were transiently elevated in 6 patients after the cardiac operation. No patient had hepatic reject ion. A transient elevation or decrease in immunosuppressive drug level s was seen in 3 patients. Follow-up, obtained on all 15 patients, rang ed from 6 to 83 months (mean, 26.5 months). There were 2 late deaths ( 13.3%), and 3 patients (25%) who underwent myocardial revascularizatio n had recurrent angina. Conclusions. Cardiac operations can be underta ken safely in liver transplant recipients with good intermediate-term results. The immunosuppression regimen can be continued at preoperativ e levels with no need for stress-dose steroids. There were no hepatic complications among our patients, although some patients can experienc e worsening of renal failure. (C) 1998 by The Society of Thoracic Surg eons.