Meta-Analysis of Postoperative Myocardial Injury as a Predictor of Mortality After Living Donor Liver Transplantation

Authors

Krzysztof Jankowski
Frank W Peacock
Michal Pruc
Teresa Malecka-Massalska
Lukasz Szarpak

Publication Date

1-1-2024

Journal

Journal of the American College of Cardiology

DOI

10.5603/CJ.a2023.0037

PMID

37246456

PMCID

PMC11706259

PubMedCentral® Posted Date

12-31-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Biomarkers, Hospital Mortality, Liver Transplantation, Living Donors, Postoperative Complications, Risk Assessment, Risk Factors, Time Factors, Troponin I, myocardial injury, mortality, living donor, liver transplantation, meta-analysis, systematic review

Abstract

BACKGROUND: The purpose of this study was to perform a systematic review and meta-analysis to investigate postoperative myocardial injury, as expressed by the postoperative concentration of high-sensitivity cardiac troponin I (hs-cTnI) as a predictor of mortality among living donor liver transplantation (LDLT) patients.

METHODS: PubMed, Scopus, Embase and the Cochrane Library were searched through to September 1st 2022. The primary endpoint included in-hospital mortality. Secondary endpoints were 1-year mortality and re-transplantation occurrence. Estimates are expressed as risk ratios (RRs) and 95% confidence intervals (95% CIs). Heterogeneity was assessed with the I² test.

RESULTS: During the search, 2 studies were found that fit the criteria and had a total of 527 patients. Pooled analysis showed that in-hospital mortality in patients with myocardial injury was 9.9%, compared to 5.0% for patients without myocardial injury (RR = 3.01; 95% CI: 0.97-9.36; p = 0.06). Mortality among 1-year follow-up was 5.0% vs. 2.4%, respectively (RR = 1.90; 95% CI: 0.41-8.81; p = 0.41).

CONCLUSIONS: In recipients with normal preoperative cTnI, myocardial injury LDLT may be associated with adverse clinical outcomes during a hospital stay, but the results were inconsistent at 1-year follow-up. Although routine follow-up of postoperative hs-cTnI, even in patients with normal preoperative levels, might still help predict the clinical outcome of LDLT. In future large and more representative studies are needed to establish the potential role of cTns in perioperative cardiac risk stratification.