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Reduced Complications after Arterial Reconnection in a Rat Model of Orthotopic Liver Transplantation
Published on: November 7, 2020
Prediction of cardiac complications after liver transplantation
Tamer R Fouad1, Wael M Abdel-Razek, Kelly W Burak
1Liver Unit, University of Calgary, Calgary, AB, Canada.
Insights
Cardiac complications are common after liver transplants and lead to death. Adverse intraoperative events, prior heart disease, and high i-MELD scores predict these post-transplant cardiac issues.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Surgery
Background:
- Orthotopic liver transplantation (OLT) imposes significant stress on the cardiovascular system.
- Cardiac complications are frequently observed following OLT.
Purpose of the Study:
- To identify predictors of cardiac complications within six months after OLT in patients aged 40 and above.
- To determine the leading causes of mortality post-OLT.
Main Methods:
- Retrospective review of 197 patients who underwent OLT between 2002 and 2007.
- Multivariate analysis was employed to identify independent predictors of cardiac complications.
Main Results:
- 82 patients experienced cardiac complications, with pulmonary edema being the most common (n=61).
- Cardiac causes were the leading cause of mortality (23.8%).
- Adverse intraoperative cardiovascular events, history of cardiac disease, and elevated i-MELD scores were independent predictors of cardiac complications and pulmonary edema.
Conclusions:
- Cardiac complications are a significant concern after OLT and contribute to mortality.
- Pre-existing cardiac conditions and severity of liver disease (i-MELD) are key risk factors.
- Intraoperative cardiovascular events strongly predict postoperative cardiac complications.
Background:
Orthotopic liver transplantation (OLT) stresses the cardiovascular system, and cardiac complications after OLT are common.
Methods:
Hundred ninety-seven patients (>or=40 years) who had OLT from 2002 to 2007 were reviewed to identify predictors of cardiac complications within 6 months after transplantation.
Results:
Median age was 56 years (40-75 years); 69% men. Reasons for OLT were hepatitis C virus (HCV) 45.5%, alcohol 22%, hepatocellular carcinoma (HCC) 8%, primary biliary cirrhosis 10%, and others 14.5%. Eighty-two patients suffered one or more cardiac complications within 6 months after OLT (pulmonary edema=61 [overt heart failure=7], arrhythmia=13, pulmonary hypertension=7, pericardial effusion=2, and right atrial thrombus=1). Cardiac causes were the leading cause of death (n=5; 23.8% of all mortality). By multivariate analysis, after adjusting for age and sex, independent predictors were adverse intraoperative cardiovascular events (adjusted odds ratio; 95% confidence interval: 5.89, 1.82-19.14), history of cardiac disease (2.42, 0.89-6.6), and i-MELD (integrated model for end-stage liver disease) score (1.08, 1.02-1.14), whereas adverse intraoperative cardiovascular events (5.73, 1.96-16.78) and i-MELD (1.07, 1.01-1.13) predicted pulmonary edema. None of the following variables predicted complications: age, sex, OLT indication, body mass index, blood pressure, alcohol and smoking history, pre-OLT investigations (chest X-ray, electrocardiogram, echocardiography, coronary angiography, pulmonary arterial pressure, and 2-methoxy isobutyl isonitrile scan), immunosuppressive treatment, or intraoperative variables (transfusion amount, cadaveric vs. living graft or cold ischemia and rewarming times).
Conclusions:
Cardiac complications after OLT are common and were the leading cause of death after surgery. Adverse intraoperative cardiovascular events, previous cardiac disease, and advanced liver disease as quantified by i-MELD score predicted postoperative cardiac complications.
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