Elevated High-Sensitivity Troponin I During Living Donor Liver Transplantation is Associated With Postoperative Adverse Outcomes

ABSTRACTBackgroundThis study aimed to evaluate risk factors and postoperative clinical outcome associated with myocardial injury detected by an elevated high-sensitivity cardiac troponin I (hs-cTnI) immediately after living donor liver transplantation (LDLT).MethodsBetween January 2011 and December 2016, 313 adult recipients undergoing LDLT, with normal preoperative hs-cTnI were selected. Hs-cTnI level above 0.04 ng/mL according to 99th percentile reference limit was defined as myocardial injury. The recipients were divided into two groups according to postoperative hs-cTnI measured immediately after LDLT and postoperative clinical outcome was compared.ResultsThe primary outcome was composite of death or graft failure during hospital stay. Risk factors associated with myocardial injury during LDLT was also evaluated. Of the 313 recipients with normal preoperative hs-cTnI level, 159 (50.8%) had elevated hs-cTnI level and 154 (49.2%) had normal level after LDLT. The incidence of all-cause death or graft failure during hospital stay was significantly higher in recipients with myocardial injury (1.9% vs. 7.6% hazard ratio, 4.15; 95% confidence interval, 1.01-17.14; P = 0.049). The same result was shown in propensity-matched population (0.9% vs. 9.0% hazard ratio, 9.08; 95% confidence interval, 1.16-71.01; P = 0.04). The results during 1-year follow-up were not consistent. Female gender, ischemia time and presence of postreperfusion syndrome were independent predictors of myocardial injury during LDLT.ConclusionMyocardial injury detected by elevation of hs-cTnI level immediately after LDLT was independently associated with adverse outcome during hospital stay. Background This study aimed to evaluate risk factors and postoperative clinical outcome associated with myocardial injury detected by an elevated high-sensitivity cardiac troponin I (hs-cTnI) immediately after living donor liver transplantation (LDLT). Methods Between January 2011 and December 2016, 313 adult recipients undergoing LDLT, with normal preoperative hs-cTnI were selected. Hs-cTnI level above 0.04 ng/mL according to 99th percentile reference limit was defined as myocardial injury. The recipients were divided into two groups according to postoperative hs-cTnI measured immediately after LDLT and postoperative clinical outcome was compared. Results The primary outcome was composite of death or graft failure during hospital stay. Risk factors associated with myocardial injury during LDLT was also evaluated. Of the 313 recipients with normal preoperative hs-cTnI level, 159 (50.8%) had elevated hs-cTnI level and 154 (49.2%) had normal level after LDLT. The incidence of all-cause death or graft failure during hospital stay was significantly higher in recipients with myocardial injury (1.9% vs. 7.6% hazard ratio, 4.15; 95% confidence interval, 1.01-17.14; P = 0.049). The same result was shown in propensity-matched population (0.9% vs. 9.0% hazard ratio, 9.08; 95% confidence interval, 1.16-71.01; P = 0.04). The results during 1-year follow-up were not consistent. Female gender, ischemia time and presence of postreperfusion syndrome were independent predictors of myocardial injury during LDLT. Conclusion Myocardial injury detected by elevation of hs-cTnI level immediately after LDLT was independently associated with adverse outcome during hospital stay. J.C.P and S.H.L contributed equally to this work. Corresponding author at: Gaab Soo Kim, MD, Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea; E-mail address: gskim@skku.edu Authorship • Participated in research design: Jungchan Park, Seung Hwa Lee, Myungsoo Park, Gaab Soo Kim • Participated in the writing of the paper: Jungchan Park, Seung Hwa Lee, Gaab Soo Kim • Participated in the performance of the research: Jungchan Park, Ki Yoon Kim, Go Eun Kim, • Contributed new reagents or analytic tools: Sangbin Han, Suk-Koo Lee, Gyu-Seong Cho • Participated in data analysis: Jungchan Park, Seung Hwa Lee, Soohyun Ahn, Hyeon Seon Ahn Disclosure: The authors declare no conflicts of interest Funding: none Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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