Clinical Factors Associated with Intraoperative Increase in Cardiac Troponin and Its Prognostic Value During Liver Transplantation

Yeon Ju Kim; Kyoung‐Sun Kim; Sung-Hoon Kim; Hye-Mee Kwon; In‐Gu Jun; Jun-Gol Song; Gyu‐Sam Hwang

doi:10.4097/kja.25982

October 22, 2026Korean Journal of AnesthesiologyOpen Access

Clinical Factors Associated with Intraoperative Increase in Cardiac Troponin and Its Prognostic Value During Liver Transplantation

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Why the study?

Does intraoperative elevation of high-sensitivity cardiac troponin I (hs-cTnI) predict 90-day all-cause mortality in adult patients undergoing liver transplantation when stratified by preoperative hs-cTnI levels?

Key Points

To evaluate the clinical factors associated with intraoperative high-sensitivity cardiac troponin I (hs-cTnI) elevation and determine its prognostic value for 90-day mortality in patients undergoing liver transplantation.
Analyzed perioperative data from 4,151 patients undergoing liver transplantation.
Categorized patients by preoperative hs-cTnI (≤ 1× URL vs. > 1× URL) and intraoperative levels (< 10× URL, 10–22× URL, and > 22× URL / > 861 pg/mL).
Evaluated 90-day all-cause mortality using Kaplan–Meier analysis and multivariable Cox proportional hazards modeling adjusting for age, sex, MELD-Na score, RCRI, and surgical year.
Intraoperative hs-cTnI > 1× URL occurred in 66.1% of patients compared with 11.2% preoperatively, with the largest relative increase observed in patients with baseline hs-cTnI ≤ 1× URL (median ratio, 7.8 vs. 1.1).
Overall 90-day mortality was 3.1% (129/4151); each doubling of intraoperative hs-cTnI was associated with increased 90-day mortality in the overall cohort (adjusted HR 1.21, 95% CI 1.11–1.32; P < 0.001) and in patients with baseline hs-cTnI > 1× URL (adjusted HR 1.29, 95% CI 1.13–1.46; P < 0.001).
Among patients with preoperative hs-cTnI > 1× URL, intraoperative hs-cTnI > 861 pg/mL was strongly associated with mortality (90-day survival 52.2% vs. 90.8% for ≤ 10× URL; adjusted HR 5.91, 95% CI 3.11–11.22, P < 0.001), whereas intraoperative levels were not significantly associated with mortality in patients with normal baseline levels (P = 0.74).

Structured PICO

Does intraoperative elevation of high-sensitivity cardiac troponin I (hs-cTnI) predict 90-day all-cause mortality in adult patients undergoing liver transplantation when stratified by preoperative hs-cTnI levels?

P

Population

4,151 adult patients undergoing liver transplantation (LT) at Asan Medical Center (Seoul, Republic of Korea) from January 2008 to October 2021 with both preoperative and intraoperative high-sensitivity cardiac troponin I (hs-cTnI) measurements. Excluded: pediatric patients (<18 years), history of cardiac valve surgery, chronic kidney disease on hemodialysis, retransplantation, or missing preoperative/intraoperative hs-cTnI measurements.

I

Intervention

Intraoperative high-sensitivity cardiac troponin I (hs-cTnI) measurement during three intraoperative phases (pre-anhepatic, anhepatic, and neohepatic), evaluating new-onset (>1x URL [40 pg/mL] or >10x URL [400 pg/mL] or >22x URL [861 pg/mL]) vs. pre-existing elevations.

C

Comparator

Patients stratified by preoperative hs-cTnI levels (<=1x URL [<=40 pg/mL], n=3,685 vs. >1x URL [>40 pg/mL], n=466) and intraoperative hs-cTnI thresholds (<=10x URL, 10-22x URL, and >22x URL).

O

Outcome

90-day all-cause mortality post-liver transplantationhard clinical

Limitations

Limited number of patients and deaths at very high hs-cTnI levels reduced statistical power in patients with normal preoperative levels
Highest intraoperative hs-cTnI value may not represent the perioperative peak because troponin concentrations may continue to rise after liver transplantation

Implication

New-onset intraoperative hs-cTnI elevations are common during liver transplantation and linked to anemia, hypercoagulability, and inflammation, but they only predict 90-day mortality in patients who already have elevated preoperative troponin levels.

Abstract

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Cite This Study

Kim et al. (2026) studied this question.

synapsesocial.com/papers/6adb45ecfa57c0e8502b9477 https://doi.org/10.4097/kja.25982

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Clinical Factors Associated with Intraoperative Increase in Cardiac Troponin and Its Prognostic Value During Liver Transplantation

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Clinical Factors Associated with Intraoperative Increase in Cardiac Troponin and Its Prognostic Value During Liver Transplantation

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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