Perioperative risk predictors of cardiac outcomes in patients undergoing liver transplantation surgery.
BACKGROUND
Cardiac risk assessment for perioperative outcomes of liver transplantation patients is limited. We examined the outcomes of an older intermediate-cardiac-risk group of patients undergoing liver transplantation surgery.


RESULTS
Patients who had liver transplantation surgery between 2001 and 2005 were studied. The 3 outcomes analyzed were nonfatal myocardial infarction, death, and either outcome within the first 30 days after the liver transplantation surgery. Of 403 patients (mean age, 52+/-9 years; 67% male), 106 (26%) were diabetic, 84 (21%) were hypertensive, and 173 (43%) had a history of smoking. There were 48 total events (12%), 25 myocardial infarctions (7%), and 38 deaths (9%) recorded during the perioperative period. From the final multivariate model, history of coronary artery disease, prior stroke, and postoperative sepsis predicted greater risk (P=0.014; odds ratio [OR], 4.0; 95% confidence interval [CI], 1.3 to 11.8; P=0.025; OR, 6.6; 95% CI, 1.3 to 33.8; and P<0.001; OR, 7.5; 95% CI, 3.3 to 17.1, respectively). Use of perioperative beta-blockers was protective (P=0.004; OR, 0.20; 95% CI, 0.1 to 0.6) for combined cardiac outcomes. For the outcome of death on multivariate analysis, postoperative sepsis and increased interventricular septal thickness predicted risk (P<0.001; OR, 8.6; 95% CI, 3.5 to 20.9; and P=0.027; OR, 2.8; 95% CI, 1.1 to 7.2, respectively), whereas the use of perioperative beta-blockers was again protective (P=0.012; OR, 0.07; 95% CI, 0.01 to 0.56).


CONCLUSIONS
In our study of cardiac risk assessment for liver transplantation surgery, history of stroke, coronary artery disease, postoperative sepsis, and increased interventricular septal thickness were markers of adverse perioperative cardiac outcomes, whereas use of perioperative beta-blockers was significantly protective.
Safadi
Anas
A
Associate Professor of Clinical Medicine, Krannert Institute of Cardiology, Room D4078, 1801 N Senate Blvd, Suite E400, Indianapolis, IN 46202-1228, USA.
Homsi
Mohamed
M
Maskoun
Waddah
W
Lane
Kathleen A
KA
Singh
Inder
I
Sawada
S G
SG
Mahenthiran
Jo
J
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D003920:Diabetes Mellitus / Q000401:mortality; D018572:Disease-Free Survival; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000401:mortality; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality*; D011183:Postoperative Complications / Q000188:drug therapy / Q000401:mortality*; D011237:Predictive Value of Tests; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality; D017678:Sex Distribution; D012907:Smoking / Q000401:mortality; D020521:Stroke / Q000401:mortality
D000319:Adrenergic beta-Antagonists