BACKGROUND Liver transplant (LT) recipients have an increased risk for the development of postoperative atrial fibrillation (POAF). POAF has been associated with serious long-term outcomes such as thromboembolic events, stroke, heart failure, and even graft instability. MATERIAL AND METHODS We assessed potential clinical, biochemical, and ECG predictors of POAF in LT recipients between 2012 and 2024.The patients were divided into 2 groups: POAF and non-POAF (34.5%, n: 38 and 65.4, n: 72, respectively). RESULTS Basal characteristics and comorbidities of the 2 groups were similar. Patients in the POAF group had significantly higher heart rates (81.16±18.62 bpm vs 65.11±12.47 bpm, P<0.01) and longer maximal P-wave durations (169.47±20.41ms vs 145.06±33.99 ms, P<0.01). Maximal P-wave duration, PR interval, P-wave peak time in lead II (PWPT-II), QRS duration, and QTc interval were also significantly longer in the POAF group compared to the non-POAF group. With these consistent findings, we may consider that changes or abnormalities in P-wave indices are significant indicators of atrial conduction delay, even before the development of LA enlargement. CONCLUSIONS Our results are valuable in providing the prediction of POAF, which may be associated with major adverse outcomes such as mortality in LT recipients, using a simple and inexpensive tool like ECG. Such risks can be minimized by strategies such as optimization of beta-blocker therapy, fluid and electrolyte balance, and intraoperative temperature regulation.

BACKGROUND Living donor liver transplantation (LDLT) has been shown to be safe in the curative treatment of liver cirrhosis. Portal flow modulation techniques, such as splenic artery ligation (SAL), have been used to avoid complications like small-for-size syndrome (SFSS). However, the effects of SAL on portal flow, splenic function, and hematologic outcomes remain underexplored. MATERIAL AND METHODS This retrospective study analyzed 60 LDLT recipients treated at a single center from January 2023 to December 2024. Thirty patients underwent SAL (SAL+) while 30 did not undergo SAL (SAL-). Data on demographic and clinical characteristics, portal flow dynamics, spleen volume, hematologic parameters, and postoperative complications were collected and analyzed using IBM SPSS 20.0. Statistical significance was set at P<0.05. RESULTS SAL significantly reduced portal flow from 3148±989 mL/min to 1949±830 mL/min (P<0.001), optimizing the portal flow/graft weight ratio. SAL also decreased splenic volume by 21% and alleviated thrombocytopenia, with postoperative platelet counts increasing 3.8-fold compared to preoperative levels (P<0.001). There were fewer complications in the SAL+ group, with significant reductions in biliary complications and improved graft function. No severe ischemic splenic changes or thromboembolic events were observed in the SAL+ group. CONCLUSIONS SAL is an effective strategy for portal flow modulation in LDLT, significantly reducing portal flow to optimal levels and improving hematologic outcomes. By preserving splenic function and minimizing complications, SAL is a safe and beneficial approach to managing SFSS and improving graft performance in LDLT patients.

Background: End-stage liver disease (ESLD) patients frequently exhibit comorbid coronary artery disease (CAD), complicating liver transplantation (LT) due to increased perioperative cardiovascular risk. In patients for whom percutaneous coronary intervention (PCI) is not feasible, coronary artery bypass grafting (CABG) may be required prior to or during LT. Off-pump CABG (OPCAB) presents a promising strategy to minimize the hemodynamic and inflammatory burdens associated with cardiopulmonary bypass, especially in ESLD patients undergoing major surgery.Case presentations: We present two male patients (aged 60 and 61) with ESLD and significant LAD stenosis who underwent simultaneous OPCAB and living donor liver transplantation (LDLT). The first case involved cryptogenic cirrhosis and recurrent variceal bleeding; the second had HBV/HDV-related cirrhosis and hepatocellular carcinoma. In both cases, OPCAB was performed using the left internal mammary artery (LIMA) graft on a beating heart. Subsequently, LDLT was carried out using standard piggy-back techniques. Portal pressure modulation via splenic artery ligation was performed in the first case due to elevated post-reperfusion portal flow. Anesthetic management emphasized hemodynamic monitoring and stability. Both patients were extubated on postoperative day one, discharged with triple immunosuppression, and followed for 6–12 months with preserved cardiac and graft function. A bile leak from the cystic duct anastomosis was encountered in one case.Conclusion: Simultaneous OPCAB and LDLT is a feasible and safe approach in carefully selected ESLD patients with CAD when performed by experienced multidisciplinary teams. Avoiding PCI mitigates bleeding risks associated with dual antiplatelet therapy, while OPCAB circumvents the deleterious effects of cardiopulmonary bypass. This strategy may shorten transplant wait times and optimize both cardiac and hepatic outcomes in high-risk populations.