Publication: Myocardial injury in patients with hemodynamic derangements during and/or after liver transplantation
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Issued Date
2016-12-01
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ISSN
13990012
09020063
09020063
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2-s2.0-84991510643
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Mahidol University
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SCOPUS
Bibliographic Citation
Clinical Transplantation. Vol.30, No.12 (2016), 1552-1557
Suggested Citation
Shun Huang, Worapot Apinyachon, Vatche G. Agopian, Christopher L. Wray, Ronald W. Busuttil, Randolph H. Steadman, Victor W. Xia Myocardial injury in patients with hemodynamic derangements during and/or after liver transplantation. Clinical Transplantation. Vol.30, No.12 (2016), 1552-1557. doi:10.1111/ctr.12855 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/40964
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Title
Myocardial injury in patients with hemodynamic derangements during and/or after liver transplantation
Abstract
© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Myocardial injury, defined as an elevation of cardiac troponin (cTn) resulting from ischemia, is associated with substantial mortality in surgical patients, and its incidence, risk factors, and impact on patients undergoing liver transplantation (LT) are poorly understood. In this study, adult patients who experienced perioperative hemodynamic derangements and had cTn measurements within 30 days after LT between 2006 and 2013 were studied. Of 502 patients, 203 (40.4%) met the diagnostic criteria (cTn I ≥0.1 ng/mL) of myocardial injury. The majority of myocardial injury occurred within the first three postoperative days and presented without clinical signs or symptoms of myocardial infarction. Thirty-day mortality in patients with myocardial injury was 11.4%, significantly higher compared with that in patients without myocardial injury (3.4%, P<.01). Cox analysis indicated the peak cTn was significantly associated with 30-day mortality. Multivariable logistic analysis identified three independent risk factors: requirement of ventilation before transplant (odds ratios (OR) 1.6, P=.006), RBC≥15 units (OR 1.7, P=.006), and the presence of PRS (OR 2.0, P=.028). We concluded that post-LT myocardial injury in this high-risk population was common and associated with mortality. Our findings may be used in pretransplant stratification. Further studies to investigate this postoperative cardiac complication in all LT patients are warranted.