Browsing by Author "Soontarinka S."

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    Incidence, Outcomes, and Risk Factors of Intraoperative Cardiac Arrest During Orthotopic Liver Transplantation
    (2024-01-01) Tovikkai P.; Suphathamwit A.; Raksakietisak M.; Tovikkai C.; Siriussawakul A.; Sujirattanawimol K.; Piriyapatsom A.; Pongraweewan O.; Tankul R.; Hemtanon N.; Boonyakarn S.; Noinonthong C.; Rattanaruangrit C.; Soontarinka S.; Tovikkai P.; Mahidol University
    Background: Intraoperative cardiac arrest (ICA) during liver transplantation (LT) is a rare surgical complication that results in devastating outcomes. Moreover, previous worldwide studies have found inconsistencies in the risk factors associated with ICA in LT. Methods: This was a retrospective cohort study of adult patients who underwent LT between January and October 2021 at Siriraj Hospital, a tertiary care hospital. The incidence of ICA and outcomes of patients who experienced ICA were examined. Risk factors associated with ICA were investigated as a secondary objective. Results: Among 342 patients, the incidence of ICA was 3.5% (95% CI 1.8%-6.1%). Of these, 33.3% died intraoperatively. Among patients with ICA, 41.7% died within 30 days, compared with only 7.6% in those without ICA (P = .002). Moreover, the in-hospital mortality rate of those with ICA was 58.3%, which was significantly higher than that of those without ICA (9.7%, P < .001). However, 41.7% of patients with ICA were discharged alive with long-term survival. Because ICA is a rare event, we found only 2 independent factors significantly associated with ICA. These factors include intraoperative temperature below 35°C, with an odds ratio (OR) of 6.07 (95% CI:1.32-27.88, P = .02) and elevated intraoperative serum potassium, with an OR of 4.57 (95% CI:2.15-9.67, P < .001). Conclusions: ICA is associated with high perioperative and in-hospital mortality. However, our findings suggest that with effective management of ICA, more than 40% of these patients could be discharged with excellent long-term outcomes. Hypothermia and hyperkalemia were independent risk factors significantly associated with ICA.
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    The association of intraoperative hypotension during orthotopic liver transplantation and post-transplant outcomes
    (2025-01-01) Tovikkai P.; Soontarinka S.; Raksakietisak M.; Tovikkai C.; Pongraweewan O.; Siriussawakul A.; Sujirattanawimol K.; Piriyapatsom A.; Tankul R.; Hemtanon N.; Noinonthong C.; Rattanaruangrit C.; Boonyakarn S.; Suphathamwit A.; Tovikkai P.; Mahidol University
    Background: Liver transplantation (LT) is one of the most high-risk noncardiac surgeries. Several risk factors have been associated with adverse outcomes in noncardiac surgery. However, limited evidence exists regarding the association between intraoperative hypotension (IOH) and post-transplant adverse outcomes. Methods: This retrospective cohort study evaluated outcomes in consecutive adult LT patients from January 2002 to October 2021. The study aimed to determine the association between IOH, defined as systolic blood pressure <80 mmHg, and post-transplant adverse outcome, defined as a composition of 30-day mortality and graft failure. Secondary outcomes encompassed postoperative complications and risk factors contributing to IOH. Results: Among the 342 patients, the incidence of IOH was 39.2 %. Post-transplant adverse outcomes were observed in 33 patients (9.7 %). Patients with IOH experienced an increased risk of post-transplant adverse outcome [OR (95%CI): 4.10 (1.88–8.93), p < 0.001]. The effect was amplified with severity and duration of IOH. Moreover, the incidence of various adverse events, including 30-day mortality, reoperation, postoperative acute kidney injury, postoperative renal replacement therapy, and prolonged intubation significantly increased in those with IOH. In multivariable analysis, the independent risk factors for IOH included age over 60 years, a history of LT, preoperative INR >1.5, and intraoperative hyperkalemia. Conclusions: IOH is significantly associated with post-transplant adverse outcomes in liver transplantation patients. The impact was amplified with severity and duration of IOH. Consequently, IOH should be proactively and aggressively managed in patients who exhibit risk factors such as advanced age, a history of LT, coagulopathy, and hyperkalemia.