Online first
Original Article
Published online: 2023-05-26

open access

Page views 672
Article views/downloads 263
Get Citation

Connect on Social Media

Connect on Social Media

Meta-analysis of postoperative myocardial injury as a predictor of mortality after living donor liver transplantation

Krzysztof Jankowski12, Frank W. Peacock3, Michal Pruc45, Teresa Malecka-Massalska6, Lukasz Szarpak378

Abstract

Background: The purpose of this study was to perform a systematic review and meta-analysis to investigate postoperative myocardial injury, as expressed by the postoperative concentration of high-sensitivity cardiac troponin I (hs-cTnI) as a predictor of mortality among living donor liver transplantation (LDLT) patients. Methods: PubMed, Scopus, Embase and the Cochrane Library were searched through to September 1st 2022. The primary endpoint included in-hospital mortality. Secondary endpoints were 1-year mortality and re-transplantation occurrence. Estimates are expressed as risk ratios (RRs) and 95% confidence intervals (95% CIs). Heterogeneity was assessed with the I2 test. Results: During the search, 2 studies were found that fit the criteria and had a total of 527 patients. Pooled analysis showed that in-hospital mortality in patients with myocardial injury was 9.9%, compared to 5.0% for patients without myocardial injury (RR = 3.01; 95% CI: 0.97–9.36; p = 0.06). Mortality among 1-year follow-up was 5.0% vs. 2.4%, respectively (RR = 1.90; 95% CI: 0.41–8.81; p = 0.41). Conclusions: In recipients with normal preoperative cTnI, myocardial injury LDLT may be associated with adverse clinical outcomes during a hospital stay, but the results were inconsistent at 1-year follow-up. Although routine follow-up of postoperative hs-cTnI, even in patients with normal preoperative levels, might still help predict the clinical outcome of LDLT. In future large and more representative studies are needed to establish the potential role of cTns in perioperative cardiac risk stratification.

Article available in PDF format

View PDF Download PDF file

References

  1. Bossone E, Cademartiri F, AlSergani H, et al. Preoperative assessment and management of cardiovascular risk in patients undergoing non-cardiac surgery: implementing a systematic stepwise approach during the COVID-19 pandemic era. J Cardiovasc Dev Dis. 2021; 8(10).
  2. Sellers D, Srinivas C, Djaiani G. Cardiovascular complications after non-cardiac surgery. Anaesthesia. 2018; 73(Suppl 1): 34–42.
  3. Smilowitz NR, Guo Yu, Rao S, et al. Perioperative cardiovascular outcomes of non-cardiac solid organ transplant surgery. Eur Heart J Qual Care Clin Outcomes. 2019; 5(1): 72–78.
  4. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130(24): 2215–2245.
  5. Raval Z, Harinstein ME, Skaro AI, et al. Cardiovascular risk assessment of the liver transplant candidate. J Am Coll Cardiol. 2011; 58(3): 223–231.
  6. Puelacher C, Lurati Buse G, Seeberger D, et al. Perioperative myocardial injury after noncardiac surgery: incidence, mortality, and characterization. Circulation. 2018; 137(12): 1221–1232.
  7. Botto F, Alonso-Coello P, Chan MTV, et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology. 2014; 120(3): 564–578.
  8. Siniscalchi A, Gamberini L, Laici C, et al. Post reperfusion syndrome during liver transplantation: from pathophysiology to therapy and preventive strategies. World J Gastroenterol. 2016; 22(4): 1551–1569.
  9. Mendes-Braz M, Elias-Miró M, Jiménez-Castro MB, et al. The current state of knowledge of hepatic ischemia-reperfusion injury based on its study in experimental models. J Biomed Biotechnol. 2012; 2012: 298657.
  10. Duchnowski P, Hryniewiecki T, Kuśmierczyk M, et al. Postoperative high-sensitivity troponin T as a predictor of sudden cardiac arrest in patients undergoing cardiac surgery. Cardiol J. 2019; 26(6): 777–781.
  11. Luchian ML, Motoc AI, Lochy S, et al. Troponin T in COVID-19 hospitalized patients: kinetics matter. Cardiol J. 2021; 28(6): 807–815.
  12. Lippi G, Sanchis-Gomar F. Cardiac troponin I and T: exploring popularity with Google Trends. Cardiol J. 2020; 27(6): 902–903.
  13. Demirel B, Ergin M, Teke C. Association of carbon monoxide ratio with neutrophil-lymphocyte ratios and cardiac indicators in carbon monoxide intoxication; a pilot study. Disaster Emerg Med J. 2020; 5(4): 190–192.
  14. Ünlü S, Şahinarslan A, Sezenöz B, et al. High-sensitive troponin T increase after hemodialysis is associated with left ventricular global longitudinal strain and ultrafiltration rate. Cardiol J. 2020; 27(4): 376–383.
  15. Weber M, Luchner A, Seeberger M, et al. Incremental value of high-sensitive troponin T in addition to the revised cardiac index for peri-operative risk stratification in non-cardiac surgery. Eur Heart J. 2013; 34(11): 853–862.
  16. Humble CAS, Huang S, Jammer Ib, et al. Prognostic performance of preoperative cardiac troponin and perioperative changes in cardiac troponin for the prediction of major adverse cardiac events and mortality in noncardiac surgery: a systematic review and meta-analysis. PLoS One. 2019; 14(4): e0215094.
  17. Puelacher C, Gualandro DM, Lurati Buse G, et al. Etiology of peri-operative myocardial infarction/injury after noncardiac surgery and associated outcome. J Am Coll Cardiol. 2020; 76(16): 1910–1912.
  18. Arslani K, Gualandro DM, Puelacher C, et al. Cardiovascular imaging following perioperative myocardial infarction/injury. Sci Rep. 2022; 12(1): 4447.
  19. Puelacher C, Lurati Buse G, Seeberger D, et al. Perioperative myocardial injury after noncardiac surgery: incidence, mortality, and characterization. Circulation. 2018; 137(12): 1221–1232.
  20. Malik MU, Russell SD, Pustavoitau A, et al. The predictors of post-transplant coronary events among liver transplant recipients. Hepatol Int. 2016; 10(6): 974–982.
  21. Halvorsen S, Mehilli J, Cassese S, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022; 43(39): 3826–3924.
  22. Page M, McKenzie J, Bossuyt P, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021: n71.
  23. Wells G, Shea B, O’Connell D, et al. Newcastle-Ottawa Quality Assessment Scale Cohort Studies. 2014. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (accessed 20 September 2022).
  24. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5: 13.
  25. Higgins JPT, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003; 327(7414): 557–560.
  26. Canbolat IP, Adali G, Akdeniz CS, et al. Postoperative myocardial injury does not predict early and 1-year mortality after living donor liver transplantation. Transplant Proc. 2019; 51(7): 2478–2481.
  27. Park J, Lee SH, Han S, et al. Elevated high-sensitivity troponin i during living donor liver transplantation is associated with postoperative adverse outcomes. Transplantation. 2018; 102(5): e236–e244.
  28. Mandell MS, Kay J. High-sensitivity troponins in liver transplantation: how will they change our practice? Transplantation. 2018; 102(5): 716–717.
  29. Sessler DI, Devereaux PJ. Perioperative troponin screening. Anesth Analg. 2016; 123(2): 359–360.
  30. Park J, Lee SH, Han S, et al. Preoperative cardiac troponin level is associated with all-cause mortality of liver transplantation recipients. PLoS One. 2017; 12(5): e0177838.
  31. Coss E, Watt KDS, Pedersen R, et al. Predictors of cardiovascular events after liver transplantation: a role for pretransplant serum troponin levels. Liver Transpl. 2011; 17(1): 23–31.