TY - JOUR
T1 - Cardiac events within the 30-day postoperative period is associated with increased 1-year mortality among deceased-donor liver transplant recipients
AU - James, Theodore W.
AU - Shay, Jessica E.S.
AU - Furfaro, David
AU - Ozseker, Burak
AU - Russell, Stuart D.
AU - Pustavoitau, Aliaksei
AU - Rizkalla, Nicole
AU - Saberi, Behnam
AU - Philosophe, Benjamin
AU - Cameron, Andrew M.
AU - Gurakar, Ahmet
N1 - Funding Information:
From the 1Osler Internal Medicine Residency Program, the 2Division of Cardiology, the 3Division of Liver Transplantation, Department of Anesthesiology and Critical Care, the 4Transplant Hepatology, Division of Gastroenterology and Hepatology, and the 5Division of Liver Transplantation, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Acknowledgements: The authors have no conflicts of interest to disclose. Statistical analysis was funded by the National Center for Research Resources and the National Center for Advancing Translational Sciences through National Institutes of Health Grant 1UL1TR001079. We acknowledge Carol Thompson and Sarah Salter who performed statistical analysis and consult for the project. *Theodore W. James and Jessica E. S. Shay contributed equally to this work. Corresponding author: Ahmet Gurakar, Johns Hopkins University School of Medicine, Transplant Hepatology, Division of Gastroenterology and Hepatology, 720 Rutland Avenue, Ross Research Building #918, Baltimore, Maryland, USA Phone: +1 410 614 3369 E-mail: aguraka1@jhmi.edu
Publisher Copyright:
© Başkent University 2019 Printed in Turkey. All Rights Reserved.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/6
Y1 - 2019/6
N2 - Objectives: Each year in the United States, approximately 40 000 patients with a liver disorder will progress to end-stage liver disease and about 30 000 of those patients will subsequently die from this condition. Liver transplant remains the definitive treatment option for end-stage liver disease, and understanding the causes of posttransplant mortality is an ongoing area of investigation. Materials and Methods: In this retrospective cohort study, patients who underwent orthotopic liver transplant between January 2012 and January 2015 at the Johns Hopkins Hospital Liver Transplant Program were reviewed by a single reviewer for cardiac events in the 30 days after transplant or during the index admission. Results: Of the 145 patients included, 30 (20.6%) were identified as having experienced a cardiac event during the defined postoperative period. Overall 1-year mortality for the cohort of 145 patients was 11.7%; however, 1-year mortality in those who had a cardiac event was 36.7% compared with 5.2% in the noncardiac event group (odds ratio = 18.17; P < .001). Although there was a statistically significant difference in age between the groups (58.6 vs 52.3 years old), once accounted for in multivariate analysis, a posttransplant cardiac event was still a statistically significant variable in 1-year mortality (odds ratio = 89.16; 95% confidence interval, 2.71-2933.95; P = .012). Similarly, hepatocellular carcinoma, sex, age, and presence of diabetes had little effect on 1-year mortality when we compared those patients who experienced a cardiac event in the first 30 days versus those who did not (odds ratio = 100.82; 95% confidence interval, 2.15-4726.12; P = .019). Conclusions: Recipients who experience cardiac events within 30 days after transplant have increased 1-year posttransplant mortality. This highlights the importance of cardiac risk stratification before transplant.
AB - Objectives: Each year in the United States, approximately 40 000 patients with a liver disorder will progress to end-stage liver disease and about 30 000 of those patients will subsequently die from this condition. Liver transplant remains the definitive treatment option for end-stage liver disease, and understanding the causes of posttransplant mortality is an ongoing area of investigation. Materials and Methods: In this retrospective cohort study, patients who underwent orthotopic liver transplant between January 2012 and January 2015 at the Johns Hopkins Hospital Liver Transplant Program were reviewed by a single reviewer for cardiac events in the 30 days after transplant or during the index admission. Results: Of the 145 patients included, 30 (20.6%) were identified as having experienced a cardiac event during the defined postoperative period. Overall 1-year mortality for the cohort of 145 patients was 11.7%; however, 1-year mortality in those who had a cardiac event was 36.7% compared with 5.2% in the noncardiac event group (odds ratio = 18.17; P < .001). Although there was a statistically significant difference in age between the groups (58.6 vs 52.3 years old), once accounted for in multivariate analysis, a posttransplant cardiac event was still a statistically significant variable in 1-year mortality (odds ratio = 89.16; 95% confidence interval, 2.71-2933.95; P = .012). Similarly, hepatocellular carcinoma, sex, age, and presence of diabetes had little effect on 1-year mortality when we compared those patients who experienced a cardiac event in the first 30 days versus those who did not (odds ratio = 100.82; 95% confidence interval, 2.15-4726.12; P = .019). Conclusions: Recipients who experience cardiac events within 30 days after transplant have increased 1-year posttransplant mortality. This highlights the importance of cardiac risk stratification before transplant.
KW - Candidate
KW - Coronary artery calcium score
KW - Coronary artery disease
KW - End-stage liver disease
KW - Liver transplantation
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U2 - 10.6002/ect.2017.0276
DO - 10.6002/ect.2017.0276
M3 - Article
C2 - 30084756
AN - SCOPUS:85067275459
VL - 17
SP - 370
EP - 374
JO - Experimental and Clinical Transplantation
JF - Experimental and Clinical Transplantation
SN - 1304-0855
IS - 3
ER -