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Liver transplantation stresses the cardiovascular system, and limited preoperative cardiac reserve may be associated with poor outcomes postoperatively. History of cardiac disease is an important predictor of perioperative morbidity and mortality in patients undergoing liver transplantation.1 Coronary artery disease (CAD) has been known to adversely affect the outcome of patients undergoing liver transplantation. High resting cardiac output (CO) and low systemic vascular resistance (SVR) in end-stage liver disease (ESLD) and perioperative haemodynamic alterations during surgery contribute adversely to the outcome.2 High morbidity and mortality in CAD patients undergoing orthotopic liver transplantation (OLT) are likely to be multifactorial. Cardiac function of the transplant recipient must be adequate to handle marked perioperative haemodynamic alterations. Additionally, in the immediate postoperative period, SVR is elevated and CO is decreased as normal liver function is reestablished. We present a challenging anesthetic management of a 62 yr male with h/o CABG for triple vessel disease (15months ago) with poor LV function and Pulmonary artery hypertension for living related liver transplantation. The patient was a case of Hepatitis C related ESLD (Meld 10, Child B), decompensated with massive ascitis, UGI bleed and progressive jaundice. The

Perioperative management of liver transplantation in a post CABG patient with very low ejection fraction – A challenging case