*Purpose: Evaluate risk factors and outcomes of combined liver transplantation (OLT) and cardiac surgery, including coronary artery grafting and valve replacement.

*Methods: Between 1/2005 and 8/2018, 1362 patients underwent OLT at our institution. 19 of them underwent combined liver transplantation and cardiac surgery. Retrospective analysis using logistic regression was conducted to assess the impact of demographics, pre-operative, intraoperative and post-operative variables on morbidity and mortality. Odds ratio and 95% confidence intervals were calculated. A predictive model of morbidity and mortality was established and statistically validated.

*Results: At the time of liver transplant, eight patients underwent CABG, eight underwent valve replacement and three underwent CABG + valve replacement. Mean age was 59 ± 9, mean cardiac Euroscore was 5.3± 3.3 and mean MELD score was 20 ± 6. Statistically significant association was found between baseline eGFR and mortality (OR= 0.953, P= 0.05) and morbidity (OR= 0.95, P= 0.048). Predictive plots demonstrated solid correlation between pre-operative renal function and morbidity and mortality (Figure 1). Other correlations were found between dialysis post-OLT (OR= 27.5, P= 0.01)/surgical re-exploration (OR= 11, P= 0.03) and mortality, and between dialysis post-OLT (OR= 12.5, P= 0.02)/surgical re-exploration (OR= 6.6 P= 0.04) and morbidity. Overall survival rate at 1, 3 and 5 years was 91%, 85% and 77% respectively.

*Conclusions: Pre transplant renal function is the strongest predictor of mortality and morbidity for simultaneous liver transplantation and cardiac surgery independently of patient MELD score and cardiac Euroscore at the time of transplant. Predictive model was built based on our data.

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