Liver Enzyme Elevation After CABG

Mechanisms and Patterns

Global or regional ischemia related to inadequate intra-operative cardiac protection can affect liver perfusion and function, according to the American College of Cardiology 1
Microvascular events related to reperfusion and oxygen free radical generation during CABG can cause hepatocellular damage, as reported by the American College of Cardiology 1
Approximately 2% of patients show elevated liver enzymes (alanine and aspartate transaminases) in the weeks to months after surgery, as noted by the American Heart Association in Circulation 2
Cardiac biomarker release is considerably higher after valve replacement with CABG than with bypass surgery alone, and with on-pump CABG compared to off-pump CABG, according to the American College of Cardiology 1

Most post-CABG liver enzyme elevations are transient and not associated with permanent hepatotoxicity or increased risk of hepatitis, as stated by the American Heart Association in Circulation 2
No data are available to suggest that these elevations are associated with permanent liver damage, as reported by the American Heart Association in Circulation 2
The presence of active or chronic liver disease is a contraindication to statin use, which is commonly prescribed after CABG, as noted by the American Heart Association in Circulation 2
Maintain adequate blood glucose control with continuous intravenous insulin to achieve and maintain postoperative blood glucose concentration ≤180 mg/dL, as hyperglycemia can worsen outcomes and potentially affect liver function, according to the American Heart Association in Circulation 2
Resume statin therapy when the patient is able to take oral medications, unless contraindicated by liver enzyme elevations suggesting hepatotoxicity, as recommended by the American Heart Association in Circulation 2