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(Circulation. 2009;120:1189-1194.)
© 2009 American Heart Association, Inc.

Epidemiology and Prevention

Perioperative Risk Predictors of Cardiac Outcomes in Patients Undergoing Liver Transplantation Surgery

Anas Safadi, MD; Mohamed Homsi, MD; Waddah Maskoun, MD; Kathleen A. Lane, MS; Inder Singh, MD; S.G. Sawada, MD; Jo Mahenthiran, MD

From the Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis.

Correspondence to Jo Mahenthiran, MD, FACC, Associate Professor of Clinical Medicine, Krannert Institute of Cardiology, Room D4078, 1801 N Senate Blvd, Suite E400, Indianapolis, IN 46202–1228. E-mail jmahenth{at}iupui.edu

Received January 18, 2009; accepted July 17, 2009.

Background— Cardiac risk assessment for perioperative outcomes of liver transplantation patients is limited. We examined the outcomes of an older intermediate-cardiac-risk group of patients undergoing liver transplantation surgery.

Methods and Results— Patients who had liver transplantation surgery between 2001 and 2005 were studied. The 3 outcomes analyzed were nonfatal myocardial infarction, death, and either outcome within the first 30 days after the liver transplantation surgery. Of 403 patients (mean age, 52±9 years; 67% male), 106 (26%) were diabetic, 84 (21%) were hypertensive, and 173 (43%) had a history of smoking. There were 48 total events (12%), 25 myocardial infarctions (7%), and 38 deaths (9%) recorded during the perioperative period. From the final multivariate model, history of coronary artery disease, prior stroke, and postoperative sepsis predicted greater risk (P=0.014; odds ratio [OR], 4.0; 95% confidence interval [CI], 1.3 to 11.8; P=0.025; OR, 6.6; 95% CI, 1.3 to 33.8; and P<0.001; OR, 7.5; 95% CI, 3.3 to 17.1, respectively). Use of perioperative β-blockers was protective (P=0.004; OR, 0.20; 95% CI, 0.1 to 0.6) for combined cardiac outcomes. For the outcome of death on multivariate analysis, postoperative sepsis and increased interventricular septal thickness predicted risk (P<0.001; OR, 8.6; 95% CI, 3.5 to 20.9; and P=0.027; OR, 2.8; 95% CI, 1.1 to 7.2, respectively), whereas the use of perioperative β-blockers was again protective (P=0.012; OR, 0.07; 95% CI, 0.01 to 0.56).

Conclusion— In our study of cardiac risk assessment for liver transplantation surgery, history of stroke, coronary artery disease, postoperative sepsis, and increased interventricular septal thickness were markers of adverse perioperative cardiac outcomes, whereas use of perioperative β-blockers was significantly protective.

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