Staged percutaneous coronary intervention and simultaneous coronary artery bypass grafting in living donor liver transplantation: A single-center retrospective cohort study.

Coronary artery disease in candidates of living donor liver transplantation (LDLT) requires revascularization strategies balancing cardiac risk against end-stage liver disease complexity. Data on revascularization outcomes in this setting remain scarce. We conducted a single-center retrospective cohort study of consecutive adult recipients of LDLT requiring coronary revascularization between January 2017 and April 2025; the principal outcomes evaluated were 90-day and 1-year all-cause mortality and major adverse cardiac events. Of 371 recipients, significant coronary artery disease was identified in 26 (7.0%): 15 underwent staged percutaneous coronary intervention (PCI) and 11 underwent simultaneous coronary artery bypass grafting (CABG); off-pump CABG (OPCAB) was the preferred technique, in 10 of 11 cases (90.9%). Patients in the CABG group had more advanced liver disease (Child-Pugh class C 0% vs. 45.5%; median MELD-Na 10 vs. 16) and more complex coronary anatomy, with left main coronary disease confined to this group (0% vs. 36.4%). Ninety-day all-cause mortality was 3.8% (1/26; 95% CI: 0.1%-19.6%) and 1-year mortality 7.7% (2/26; 95% CI: 0.9%-25.1%); all deaths occurred in the CABG group from noncardiac sepsis. Cardiac mortality was 0% in both groups (PCI, 95% CI: 0.0%-21.8%; CABG, 95% CI: 0.0%-28.5%); 1-year major adverse cardiac event was 0%; 1-year CABG group survival was 81.8% (95% CI: 48.2%-97.7%). No stent thrombosis occurred despite a PCI-to-LDLT interval of 20-1505 days, reflecting the scheduling flexibility unique to living donor programs. The predominant procedure-specific complication was sternotomy-related pleural effusion (0% in the PCI group vs. 63.6% in the CABG group). These preliminary findings suggest the feasibility of both staged PCI and simultaneous CABG-LDLT when the strategy is individualized by coronary anatomy and hepatic reserve, with wide confidence intervals reflecting this small cohort and underscoring the need for multicenter validation.