Anesth Pain Med.  2022 Oct;17(4):404-411. 10.17085/apm.22167.

Temporary postoperative myocardial injury and long-term survival in liver transplant patients with coronary artery disease

• Kwon HM
• Kim JH
• Yang JW
• Hwang GS

• KMID: 2535339
• DOI: http://doi.org/10.17085/apm.22167

Abstract

Background
Coronary artery disease (CAD) is increasing worldwide due to the aging population and cardiometabolic syndrome. However, the extent of postoperative myocardial injury, the most common cause of death during the 30 days after noncardiac surgery, remains unclear with respect to liver transplant (LT) patients with CAD. We examined the link between post-LT high sensitivity cardiac troponin I (hs_cTnI) and long-term survival according to liver disease severity.
Methods
Consecutive patients who underwent LT (n = 3,220) from 2010 to 2020 were evaluated retrospectively. CAD was defined as a history of coronary artery bypass surgery or percutaneous intervention, or previous myocardial infarction. Peak hs_cTnI levels within 30 days post-transplant were compared in patients with and without CAD. The primary endpoint was defined as an all-cause mortality at 12 years following LT. Secondary endpoints include peak hs_cTnI level within post-transplant 30 days and 30-day mortality. Survival analysis was performed using the Kaplan–Meier method.
Results
CAD patients (n = 264, 8.2%) had higher peak hs_cTnI levels within 30 days post-LT than those without CAD (median [interquartile]: 0.068 [0.030–0.154] vs. 0.087 [0.037–0.203] ng/ml, respectively; P = 0.004); however, the mortality rate was comparable (14.7% vs. 14.8%, respectively, P = 0.999), at 12 years, and 1.9% vs. 1.1% (P = 0.522) at 30 days, respectively, at 30 days. Subgroup analysis with stratified liver disease severity identified a similar risk of long-term mortality.
Conclusions
Although the peak hs_cTnI level within 30 days was higher in revascularized or treated CAD patients after LT compared those without CAD, long-term mortality rates at 12 years and 30-day mortality rate were comparable.

Keyword

Coronary artery disease; Liver transplant; Mortality; Troponin I

Figure

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  Fig. 1. Flow diagram of current study.

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  Fig. 2. Kaplan–Meier plot showing cumulative overall survival rate between patients with and without coronary artery disease (CAD).

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  Fig. 3. Impact of coronary artery disease (CAD) prevalence on cumulative overall survival rate between patients with low (≤ 0.04 ng/ml) and high (> 0.04 ng/ml) troponin I (TnI).

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  Fig. 4. Uni- and multivariable cox regression analysis with long-term mortality rates at 12 years. BMI: body mass index, MELD: model for end-stage liver disease, RBC: red blood cell, PRS: post-reperfusion syndrome, CAD: coronary artery disease, CI: confidence interval.

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  Fig. 5. Kaplan–Meier plot of cumulative overall survival rate between patients with and without coronary artery disease (CAD), in subset of patients with MELD score of < 16, 16–30, or > 30. MELD: model for end-stage liver disease.

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