Incidence and predictors of postoperative atrial fibrillation in kidney transplant recipients.
BACKGROUND
Postoperative atrial fibrillation (POAF) is a complication of cardiothoracic and noncardiothoracic surgery. Kidney transplant recipients bear several known risk factors and may have a higher incidence of POAF. We retrospectively studied kidney and kidney/liver transplant recipients to estimate their POAF incidence and identify relevant risk factors. We also adapted a clinical score originally designed to predict thromboembolic risk in atrial fibrillation (AF; CHA2DS2-VASc) for assessing transplant patients.


METHODS
We reviewed the clinical charts of kidney or kidney/liver transplant recipients from January 2005 to December 2008 at St. Orsola University Hospital Kidney Transplant Centre. Patients with and without POAF were compared on a number of clinical, laboratory, and instrumental data.


RESULTS
The POAF incidence in kidney transplant recipients was 8.2%. Risk factors for POAF identified in univariate analyses included older recipient age, history of myocardial infarction, history of AF, liver/kidney transplantation, arterial stiffness, atherosclerotic plaques in the aorta or lower limbs, and diabetes mellitus. In a multivariate analysis, age, myocardial infarction history and combined liver/kidney transplantation were significant independent predictors of POAF. The modified CHA2DS2-VASc score proved to have a better predictive validity that the original CHA2DS2-VASc (area under the curve=0.71, 95% confidence interval=0.63-0.79 vs. area under the curve=0.62, 95% confidence interval=0.52-0.73, respectively).


CONCLUSIONS
AF is a notable complication of kidney, and particularly simultaneous liver/kidney, transplant surgery. Age, previous myocardial infarction, and simultaneous liver/kidney transplant independently predicted POAF. The modified CHA2DS2-VASc score could be useful to predict POAF risk in kidney transplant candidates.
1 Nephrology Dialysis and Renal Transplant Unit, St. Orsola University Hospital, Bologna, Italy. 2 Cardiology Unit, University of Bologna, St. Orsola University Hospital, Bologna, Italy. 3 Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy. 4 Address correspondence to: Gaetano La Manna, M.D., Nephrology Dialysis and Renal Transplantation Unit, St. Orsola University Hospital, Massarenti 9, Bologna, Italy.
Gaetano
G
La Manna
Giuseppe
G
Boriani
Irene
I
Capelli
Antonio
A
Marchetti
Valeria
V
Grandinetti
Alessandra
A
Spazzoli
Vittorio
V
Dalmastri
Paola
P
Todeschini
Paola
P
Rucci
Sergio
S
Stefoni
D000328:Adult; D000367:Age Factors; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome