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Published on: November 7, 2020
Surgical outcomes after cardiac surgery in liver transplant recipients
Takeyoshi Ota1, Rodolfo Rocha1, Lawrence M Wei1
1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Insights
Cardiac surgery in liver transplant recipients shows acceptable outcomes. Preoperative encephalopathy and pulmonary hypertension predict late mortality, while a Model for End-Stage Liver Disease (MELD) score of 13.5 may predict surgical mortality.
Area of Science:
- Transplant Surgery
- Cardiology
- Hepatology
Background:
- Liver transplant recipients often require subsequent cardiac surgery.
- Assessing surgical outcomes and mortality predictors in this population is crucial.
Purpose of the Study:
- To evaluate surgical outcomes of liver transplant recipients undergoing cardiac surgery.
- To identify predictors of mortality in these patients.
Main Methods:
- Retrospective analysis of 61 liver transplant recipients who underwent cardiac surgery between 2000 and 2010.
- Review of preoperative and postoperative data, including Child-Pugh class and Model for End-Stage Liver Disease (MELD) scores.
- Cox regression and Kaplan-Meier survival analyses were performed.
Main Results:
- Overall in-hospital mortality was 6.6%. 1-year and 5-year survival rates were 82.4% and 50.2%, respectively.
- Preoperative encephalopathy and pulmonary hypertension were independent predictors of late mortality.
- A MELD score cutoff of 13.5 was identified as optimal for predicting surgical mortality, with significantly different survival rates between MELD <13.5 and MELD >13.5 groups.
Conclusions:
- Cardiac surgery in liver allograft recipients is associated with acceptable outcomes.
- Preoperative encephalopathy, pulmonary hypertension, and MELD score are important factors in predicting mortality.
- A MELD score of 13.5 may serve as a useful threshold for surgical risk stratification.
Objective:
This was a single-center retrospective study to assess the surgical outcomes and predictors of mortality of liver transplant recipients undergoing cardiac surgery.
Methods:
From 2000 to 2010, 61 patients with a functioning liver allograft underwent cardiac surgery. The mean interval between liver transplantation and cardiac surgery was 5.4 ± 4.4 years. Of the 61 patients, 33 (54%) were in Child-Pugh class A and 28 in class B. The preoperative and postoperative data were reviewed.
Results:
The overall in-hospital mortality was 6.6%. The survival rate was 82.4% ± 5.1% at 1 year and 50.2% ± 8.2% at 5 years. Cox regression analysis identified preoperative encephalopathy (odds ratio, 5.2; 95% confidence interval, 1.8-15.5; P = .003) and pulmonary hypertension (odds ratio, 3.5; 95% confidence interval, 1.3-9.4; P = .045) as independent predictors of late mortality. The preoperative Model for End-Stage Liver Disease (MELD) scores of patients who died in-hospital or late postoperatively were significantly greater statistically than the scores of the others (in-hospital death, 23.7 ± 7.8 vs 13.1 ± 4.5, P < .001; late death, 15.2 ± 6.1 vs 12.3 ± 4.1, P = .038). The Youden index identified an optimal MELD score cutoff value of 13.5 (sensitivity, 56.0%; specificity, 67.6%). Kaplan-Meier survival analysis successfully demonstrated that the survival rate of the MELD score less than 13.5 (MELD <13.5) group was significantly greater than that of the MELD >13.5 group (MELD <13.5 group, 93.8% ± 4.2% at 1 year and 52.4% ± 11.8% at 5 years; MELD >13.5 group, 66.9% ± 9.6% at 1 year and 46.1% ± 11.1% at 5 years; P = .027). In contrast, the survival rate when stratified by Child-Pugh class (class A vs B) was not significantly different.
Conclusions:
Cardiac surgery in the liver allograft recipients was associated with acceptable surgical outcomes. Preoperative encephalopathy and pulmonary hypertension were independent predictors of late mortality. The cutoff value of 13.5 in the MELD score might be useful for predicting surgical mortality in cardiac surgery.
