Systematic review and meta-analysis of the co-occurrence of atrial fibrillation and liver transplantation: a lethal combination

INTRODUCTION: This systematic review and meta-analysis is aimed to evaluate the role of new-onset atrial fibrillation (NOAF) in patients after liver transplantation (LT) and determine the effect of NOAF on the incidence of mortality and graft rejection. MATERIAL AND METHODS: Published studies until the end of April 15, 2023, were systematically searched in PubMed, Google Scholar, Scopus, Embase, Web of Science, and the Cochrane databases. Odds ratios (ORs) with 95% confidence intervals (CI) for mortality and graft rejection were extracted. RESULTS: Five studies with a total of 4788 unique post-LT patients were included in the meta-analysis. Pooled analysis showed that mortality in patients with and without NOAF varied and amounted to 24.1% vs. 12.5%, respectively (OR = 2.51; 95%CI: 1.92 to 3.27; p < 0.001). Moreover, pooled analysis showed that graft rejection in the NOAF cohort was 26.3%, and was higher vs. patients without NOAF (13.1%; OR = 2.98; 95%CI: 2.14 to 4.15; p < 0.001) CONCLUSIONS: Post-LT NOAF is associated with increased mortality and a higher risk of graft rejection. It is likely that the development of a standard procedure for early identification of NOAF, as well as to develop recommendations for specific treatment targeted at avoiding the impacts of the illness, could provide a mortality reduction and provide an increased rate of successful LT.