title: Myocardial injury in patients with hemodynamic derangements during and/or after liver transplantation.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, Beijing, China.|Department of Anesthesiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Shun
authors.initials: S
authors.lastname: Huang
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Worapot
authors.initials: W
authors.lastname: Apinyachon
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Vatche G
authors.initials: VG
authors.lastname: Agopian
authors.affiliation: Department of Anesthesiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wray
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
authors.affiliation: Department of Anesthesiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Randolph H
authors.initials: RH
authors.lastname: Steadman
authors.affiliation: Department of Anesthesiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Victor W
authors.initials: VW
authors.lastname: Xia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D007432:Intraoperative Period; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011184:Postoperative Period; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014336:Troponin / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D014336:Troponin
keywords: liver transplantation; myocardial injury; perioperative management; postoperative complication; retrospective study; risk factors; troponin