Key result
Pre-transplant atrial fibrillation, present in 6.5% of patients undergoing orthotopic liver transplantation, was associated with similar in-hospital mortality but worse perioperative outcomes.
Why the study?
The authors sought to evaluate the prevalence of pre-transplant AF and its association with 30-day postoperative outcomes in patients undergoing orthotopic liver transplant.
Does pre-transplant atrial fibrillation worsen in-hospital outcomes in patients undergoing orthotopic liver transplantation?
Observational (n=45,357)
Yes
Does pre-transplant atrial fibrillation worsen in-hospital outcomes in patients undergoing orthotopic liver transplantation?
Pre-transplant atrial fibrillation in liver transplant candidates is associated with increased perioperative complications, highlighting the need for careful preoperative cardiovascular risk stratification.
INTRODUCTION: In this study, we sought to evaluate the prevalence and association of pre-transplant atrial fibrillation (AF) on 30-day postoperative outcomes in patients undergoing orthotopic liver transplant (OLT). METHOD: The National Inpatient Sample Database was queried from 2011 to 2017 for relevant ICD-9 and ICD-10 procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes were compared in patients who underwent OLT with AF and those without. RESULTS: Among 45,357 patients who underwent OLT, women made up 35.8% of the overall population. The prevalence of AF before transplant was 2932 (6.5%) with a trend toward increasing prevalence, with an average annual change rate of 4.19%. Applying propensity score matching to control for potential confounding factors, there was no association between pre-transplant AF and in-hospital mortality in patients undergoing OLT, however there was a higher incidence of perioperative complications including: acute kidney injury, ventricular tachycardia, major bleeding, blood product transfusion, and septic shock. CONCLUSION: In patients undergoing OLT, pre-transplant AF is increasing in prevalence and appears to be associated with similar in-hospital mortality but worse perioperative outcomes. Greater emphasis should be placed on AF in the preoperative cardiovascular risk stratification of patients undergoing OLT.
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Dangl et al. (2022) conducted an observational in Orthotopic liver transplantation (n=45,357). Pre-transplant atrial fibrillation vs. No pre-transplant atrial fibrillation was evaluated on In-hospital mortality. Pre-transplant atrial fibrillation, present in 6.5% of patients undergoing orthotopic liver transplantation, was associated with similar in-hospital mortality but worse perioperative outcomes.
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