Objective
The authors aimed to identify predictors of new-onset postoperative atrial fibrillation
(POAF) during the initial 90 days following liver transplantation, and to assess the
association between POAF in-hospital and 1-year mortality.
Design
A retrospective cohort study.
Setting
At a university hospital between 2005 and 2017.
Patients
Adults without a history of preoperative atrial fibrillation who underwent orthotopicliver
transplantation.
Measurement and Main Results
The authors assessed the univariate association between new-onset of POAF in the postoperative
period and each potential factor through a logistic regression model. Moreover, they
explored predictors for POAF through stepwise selection. Finally, the authors assessed
the relationship between POAF and in-hospital and 1-year mortality using logistic
regression models, and whether the duration of atrial fibrillation was associated
with in-hospital and 1-year mortality. Among 857 patients, 89 (10.4%) developed POAF.
Using only preoperative variables, pulmonary hypertension, age, Model for End-Stage
Liver Disease (MELD) score, and White race were identified as the most important predictors.
Model discrimination was 0.75 (95% CI: 0.69-0.80), and incorporating intraoperative
variables was 0.77 (95% CI: 0.72-0.82). In-hospital mortality was observed in 7.2%
(6/83) of patients with new-onset of POAF, and in 2.8% (22/768) without, with confounder-adjusted
odds ratio (OR) 1.00 (97.5% CI: 0.29,3.45; p = 0.996). One-year mortality was 22.4%
(20/89) in patients who developed POAF and 8.3% (64/768) in patients who did not,
confounder-adjusted OR 2.64 (97.5% CI: 1.35-5.16; p = 0.001). The duration of POAF
did not affect long-term postoperative mortality.
Conclusion
Preoperative, mostly unmodifiable comorbidities are important risk factors for new-onset
POAF after liver transplantation. The POAF was not associated with in-hospital mortality,
but with increased 1-year mortality. Once developed, the duration of POAF did not
affect long-term mortality after a liver transplant.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiothoracic and Vascular AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Organ Procurement and Transplantation Network. OPTN/SRTR 2019 annual data report: Liver. Available at: https://srtr.transplant.hrsa.gov/annual_reports/2019/Liver.aspx. Accessed.
- Factors associated with major adverse cardiovascular events after liver transplantation among a national sample.Am J Transplant. 2016; 16: 2684-2694
- Multidisciplinary approach to cardiac and pulmonary vascular disease risk assessment in liver transplantation: An evaluation of the evidence and consensus recommendations.Am J Transplant. 2018; 18: 30-42
- A point-based prediction model for cardiovascular risk in orthotopic liver transplantation: The CAR-OLT score.Hepatology. 2017; 66: 1968-1979
- Cardiovascular mortality following liver transplantation: Predictors and temporal trends over 30 years.Eur Heart J Qual Care Clin. 2020; 6: 243-253
- Long-term cardiovascular risk in the orthotopic liver transplant population.Liver Transpl. 2006; 12: 352-355
- Fifty-year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the community renate.Lancet. 2015; 386: 154-162
- Postoperative arrhythmias in general surgical patients.Ann R Coll Surg Engl. 2007; 89: 91-95
- Epidemiology and management of atrial fibrillation in medical and noncardiac surgical adult intensive care unit patients.J Crit Care. 2012; 27 (326.e1-8)
- Predictors, prognosis, and management of new clinically important atrial fibrillation after noncardiac surgery: A prospective cohort study.Anesth Analg. 2017; 125: 162-169
- Risk factors for intensive care unit readmission after liver transplantation: A retrospective cohort study.Ann Transplant. 2018; 23: 767-774
- Incidence and prevalence of atrial fibrillation and associated mortality among medicare beneficiaries: 1993-2007.Circ Cardiovasc Qual Outcomes. 2012; 5: 85-93
- Liver transplantation and atrial fibrillation: A meta-analysis.World J Hepatol. 2018; 10: 761-771
- Liver disease as a predictor of new-onset atrial fibrillation.J Am Heart Assoc. 2018; 7e008703
- Liver transplantation in patients with atrial fibrillation.Transplant Proc. 2013; 45: 2302-2306
- Atrial fibrillation in patients undergoing liver transplantation - A single-center experience.Transplant Proc. 2014; 46: 1432-1437
- Brief episodes of newly developed intraoperative atrial fibrillation predicts worse outcomes in adult liver transplantation.Transplant Proc. 2018; 50: 1142-1146
- Atrial fibrillation in renal or liver transplant recipients: A systematic review and meta-analysis.Transplant Rev. 2019; 33: 29-38
- Challenges to liver transplantation and strategies to improve outcomes.Gastroenterology. 2015; 148: 307-323
- Postoperative atrial fibrillation and long-term risk of stroke in patients undergoing liver transplantation.Stroke. 2021; 52: 111-120
- Postoperative atrial fibrillation and flutter in liver transplantation: An important predictor of early and late morbidity and mortality.Liver Transplant. 2020; 26: 34-44
- Postoperative atrial fibrillation in liver transplantation.Am J Transplant. 2015; 15: 687-694
- Cardiac and neurologic complications in the late period after liver transplantation: A retrospective analysis of 4 years.Transplant Proc. 2019; 51: 1153-1156
- A simulation study of the number of events per variable in logistic regression analysis.J Clin Epidemiol. 1996; 49: 1373-1379
- Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery.Can J Cardiol. 2017; 33: 17-32
- New-onset atrial fibrillation and associated outcomes and resource use among critically ill adults - a multicenter retrospective cohort study.Crit. Care Critical Care. 2020; 24: 15
- Redefining cirrhotic cardiomyopathy for the modern era.Hepatology. 2020; 71: 334-345
- The donor risk index: A decade of experience.Liver Transplant. 2017; 23: 1216-1225
Article info
Publication history
Published online: July 14, 2022
Footnotes
The study was supported with internal funds of the Department. ER received a grant from Instituto Salud Carlos III (BA18/00048).
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
