Key result
Pretransplant QTc ≥480 ms was the strongest predictor for 30-day cardiac arrest and ventricular arrhythmias following liver transplantation (OR 5.2; 95% CI 2.2-12.6).
Why the study?
Liver transplantation carries a high risk of periprocedural cardiac arrest and ventricular arrhythmias, and although QTc prolongation is common in liver cirrhosis, its association with these post-transplant events remains unclear.
Does pretransplant QTc prolongation predict 30-day cardiac arrest and ventricular arrhythmias in adults undergoing liver transplantation?
Cohort (n=408)
Single-blind
Does pretransplant QTc prolongation predict 30-day cardiac arrest and ventricular arrhythmias in adults undergoing liver transplantation?
Odds Ratio: 5.2 (95% CI 2.2–12.6)
A pretransplant QTc ≥480 ms is strongly associated with a 5-fold increased risk of 30-day cardiac arrest and ventricular arrhythmias after liver transplantation, and can be incorporated into a novel risk index (CARI) to identify high-risk patients.
May inform preoperative arrhythmia risk assessment in liver transplant candidates; hypothesis-generating pending prospective validation.
Liver transplantation (LT) has a 4-fold higher risk of periprocedural cardiac arrest and ventricular arrhythmias (CA/VAs) compared with other noncardiac surgeries. Prolongation of the corrected QT interval (QTc) is common in patients with liver cirrhosis. Whether it is associated with an increased risk of CA/VAs following LT is unclear. Rates of 30-day CA/VAs post-LT were assessed in consecutive adults undergoing LT between 2010 and 2017. Pretransplant QTc was measured by a cardiologist blinded to clinical outcomes. Among 408 patients included, CA/VAs occurred in 26 patients (6.4%). QTc was significantly longer in CA/VA patients (475 ± 34 vs 450 ± 34 ms, P < .001). Optimal QTc cut-off for prediction of CA/VAs was ≥480 ms. After adjustment, QTc ≥480 ms remained the strongest predictor for the occurrence of CA/VAs (odds ratio [OR] 5.2, 95% confidence interval [CI] 2.2-12.6). A point-based cardiac arrest risk index (CARI) was derived with the bootstrap method for yielding optimism-corrected coefficients (2 points: QTc ≥480, 1 point: Model for End-Stage Liver Disease [MELD] ≥30, 1 point: age ≥65, and 1 point: male). CARI score ≥3 demonstrated moderate discrimination (c-statistic 0.79, optimism-corrected c-statistic 0.77) with appropriate calibration. QTc ≥480 ms was associated with a 5-fold increase in the risk of CA/VAs. The CARI score may identify patients at higher risk of these events. Whether heightened perioperative cardiac surveillance, avoidance of QT prolonging medications, or beta blockers could mitigate the risk of CA/VAs in this population merits further study.
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Koshy et al. (2020) conducted a cohort in Liver transplantation (n=408). QTc prolongation (≥480 ms) vs. QTc <480 ms was evaluated on 30-day cardiac arrest and ventricular arrhythmias (CA/VAs) post-LT (OR 5.2, 95% CI 2.2-12.6). Pretransplant QTc ≥480 ms was the strongest predictor for 30-day cardiac arrest and ventricular arrhythmias following liver transplantation (OR 5.2; 95% CI 2.2-12.6).
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