Prabhakar G, Testa G, Abbasoglu O, Jeyarajah D R, Goldstein R M, Levy M F, Husberg B S, Gonwa T A, Klintmalm G B
Baylor Institute of Transplantation Sciences, Baylor University Medical Center, Dallas, Texas 75246, USA.
Ann Thorac Surg. 1998 Apr;65(4):1060-4. doi: 10.1016/s0003-4975(98)00094-0.
Advances in surgical techniques and immunosuppressive drugs have improved the survival of patients after orthotopic liver transplantation. Enhanced survival has resulted in an increased number of patients who require medical as well as surgical management of diseases.
To contribute to the sparse literature on the surgical aspects, we reviewed our experience with 15 patients who underwent cardiac operation (1.25%) from a total of 1,200 liver transplant recipients at our center. The variables studied included the pretransplant cardiac evaluation, the interval from transplantation to cardiac operation, postoperative complications, the management of immunosuppression, and follow-up. The patients had a mean age of 52.9 years (range, 39 to 69 years) and 13 of them (86.6%) were men. Multiple cardiac risk factors were present in all 15 patients and chronic renal insufficiency was present in 7 patients. Cardiac operation was undertaken a mean of 30.4 months (range, 9 days to 62 months) after myocardial ischemia and valvular regurgitation had been ruled out at the time of transplantation. Myocardial revascularization was performed in 12 patients, 2 of whom underwent concurrent valve operation and 3 of whom underwent valve repair or replacement. Most patients had their immunosuppression regimen continued at baseline levels.
There were no early deaths. Three patients had major complications and 4 had minor complications. There were no bleeding, infection, or healing complications. Postoperative renal 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 rejection. A transient elevation or decrease in immunosuppressive drug levels was seen in 3 patients. Follow-up, obtained on all 15 patients, ranged from 6 to 83 months (mean, 26.5 months). There were 2 late deaths (13.3%), and 3 patients (25%) who underwent myocardial revascularization had recurrent angina.
Cardiac operations can be undertaken safely in liver transplant recipients with good intermediate-term results. The immunosuppression regimen can be continued at preoperative levels with no need for stress-dose steroids. There were no hepatic complications among our patients, although some patients can experience worsening of renal failure.
手术技术和免疫抑制药物的进步提高了原位肝移植患者的生存率。生存率的提高导致需要药物和手术治疗疾病的患者数量增加。
为了补充有关手术方面的稀少文献，我们回顾了本中心1200例肝移植受者中15例接受心脏手术（1.25%）的经验。研究的变量包括移植前心脏评估、从移植到心脏手术的间隔时间、术后并发症、免疫抑制管理及随访情况。患者的平均年龄为52.9岁（范围39至69岁），其中13例（86.6%）为男性。所有15例患者均存在多种心脏危险因素，7例患者存在慢性肾功能不全。在移植时排除心肌缺血和瓣膜反流后，平均在30.4个月（范围9天至62个月）进行心脏手术。12例患者进行了心肌血运重建，其中2例同时进行了瓣膜手术，3例进行了瓣膜修复或置换。大多数患者的免疫抑制方案维持在基线水平。
无早期死亡病例。3例患者出现严重并发症，4例出现轻微并发症。无出血、感染或愈合并发症。5例患者术后肾脏参数持续升高，3例患者短暂升高。心脏手术后6例患者肝功能参数短暂升高。无患者发生肝排斥反应。3例患者免疫抑制药物水平出现短暂升高或降低。对所有15例患者进行随访，随访时间为6至83个月（平均26.5个月）。有2例晚期死亡（13.3%），3例接受心肌血运重建的患者（25%）出现复发性心绞痛。
肝移植受者可以安全地进行心脏手术，中期效果良好。免疫抑制方案可维持在术前水平，无需使用应激剂量的类固醇。我们的患者中未出现肝脏并发症，尽管有些患者可能会出现肾衰竭加重的情况。
