Document Detail


Prediction of cardiac complications after liver transplantation.
MedLine Citation:
PMID:  19295324     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Orthotopic liver transplantation (OLT) stresses the cardiovascular system, and cardiac complications after OLT are common. METHODS: Hundred ninety-seven patients (>or=40 years) who had OLT from 2002 to 2007 were reviewed to identify predictors of cardiac complications within 6 months after transplantation. RESULTS: Median age was 56 years (40-75 years); 69% men. Reasons for OLT were hepatitis C virus (HCV) 45.5%, alcohol 22%, hepatocellular carcinoma (HCC) 8%, primary biliary cirrhosis 10%, and others 14.5%. Eighty-two patients suffered one or more cardiac complications within 6 months after OLT (pulmonary edema=61 [overt heart failure=7], arrhythmia=13, pulmonary hypertension=7, pericardial effusion=2, and right atrial thrombus=1). Cardiac causes were the leading cause of death (n=5; 23.8% of all mortality). By multivariate analysis, after adjusting for age and sex, independent predictors were adverse intraoperative cardiovascular events (adjusted odds ratio; 95% confidence interval: 5.89, 1.82-19.14), history of cardiac disease (2.42, 0.89-6.6), and i-MELD (integrated model for end-stage liver disease) score (1.08, 1.02-1.14), whereas adverse intraoperative cardiovascular events (5.73, 1.96-16.78) and i-MELD (1.07, 1.01-1.13) predicted pulmonary edema. None of the following variables predicted complications: age, sex, OLT indication, body mass index, blood pressure, alcohol and smoking history, pre-OLT investigations (chest X-ray, electrocardiogram, echocardiography, coronary angiography, pulmonary arterial pressure, and 2-methoxy isobutyl isonitrile scan), immunosuppressive treatment, or intraoperative variables (transfusion amount, cadaveric vs. living graft or cold ischemia and rewarming times). CONCLUSIONS: Cardiac complications after OLT are common and were the leading cause of death after surgery. Adverse intraoperative cardiovascular events, previous cardiac disease, and advanced liver disease as quantified by i-MELD score predicted postoperative cardiac complications.
Authors:
Tamer R Fouad; Wael M Abdel-Razek; Kelly W Burak; Vincent G Bain; Samuel S Lee
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Transplantation     Volume:  87     ISSN:  1534-6080     ISO Abbreviation:  Transplantation     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-19     Completed Date:  2009-05-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  763-70     Citation Subset:  IM    
Affiliation:
Liver Unit, University of Calgary, Calgary, AB, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cause of Death
Electrocardiography
Female
Heart Diseases / classification,  epidemiology*,  mortality
Humans
Intraoperative Complications / chemically induced,  epidemiology
Liver Diseases / classification,  surgery
Liver Transplantation / adverse effects*
Male
Middle Aged
Postoperative Complications / classification,  epidemiology
Predictive Value of Tests
Preoperative Care
Radiography, Thoracic
Retrospective Studies
Severity of Illness Index

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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