Chokesuwattanaskul Ronpichai, Thongprayoon Charat, Bathini Tarun, Ungprasert Patompong, Sharma Konika, Wijarnpreecha Karn, Pachariyanon Pavida, Cheungpasitporn Wisit
Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand.
Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, United States.
World J Hepatol. 2018 Oct 27;10(10):761-771. doi: 10.4254/wjh.v10.i10.761.
To assess prevalence of pre-existing atrial fibrillation (AF) and/or incidence of AF following liver transplantation, and the trends of patient's outcomes overtime; to evaluate impact of pre-existing AF and post-operative AF on patient outcomes following liver transplantation.
A literature search was conducted utilizing MEDLINE, EMBASE and Cochrane Database from inception through March 2018. We included studies that reported: (1) prevalence of pre-existing AF or incidence of AF following liver transplantation; or (2) outcomes of liver transplant recipients with AF. Effect estimates from the individual study were extracted and combined utilizing random-effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews, No. CRD42018093644).
Twelve observational studies with a total of 38586 liver transplant patients were enrolled. Overall, the pooled estimated prevalence of pre-existing AF in patients undergoing liver transplantation was 5.4% (95%CI: 4.9%-5.9%) and pooled estimated incidence of AF following liver transplantation was 8.5% (95%CI: 5.2%-13.6%). Meta-regression analyses were performed and showed no significant correlations between year of study and either prevalence of pre-existing AF ( = 0.08) or post-operative AF after liver transplantation ( = 0.54). The pooled OR of mortality among liver transplant recipients with pre-existing AF was 2.34 (2 studies; 95%CI: 1.10-5.00). In addition, pre-existing AF is associated with postoperative cardiovascular complications among liver transplant recipients (3 studies; OR: 5.15, 95%CI: 2.67-9.92, = 64%). With limited studies, two studies suggested significant association between new-onset AF and poor clinical outcomes including mortality, cerebrovascular events, post-transplant acute kidney injury, and increased risk of graft failure among liver transplant recipients ( < 0.05).
The overall estimated prevalence of pre-existing AF and incidence of AF following liver transplantation are 5.4% and 8.5%, respectively. Incidence of AF following liver transplant does not seem to decrease overtime. Pre-existing AF and new-onset AF are potentially associated with poor clinical outcomes post liver transplantation.
评估肝移植前存在的心房颤动（AF）的患病率和/或肝移植后AF的发生率，以及患者预后随时间的变化趋势；评估肝移植前存在的AF和术后AF对肝移植患者预后的影响。
利用MEDLINE、EMBASE和Cochrane数据库进行文献检索，检索时间从数据库建立至2018年3月。我们纳入了报告以下内容的研究：（1）肝移植前存在的AF的患病率或肝移植后AF的发生率；或（2）患有AF的肝移植受者的预后。提取个体研究的效应估计值，并采用DerSimonian和Laird的随机效应、通用逆方差法进行合并。该荟萃分析的方案已在PROSPERO（国际系统评价前瞻性注册库，编号CRD42018093644）注册。
纳入了12项观察性研究，共38586例肝移植患者。总体而言，肝移植患者中肝移植前存在的AF的合并估计患病率为5.4%（95%CI：4.9%-5.9%），肝移植后AF的合并估计发生率为8.5%（95%CI：5.2%-13.6%）。进行了荟萃回归分析，结果显示研究年份与肝移植前存在的AF的患病率（P = 0.08）或肝移植后AF的发生率（P = 0.54）之间均无显著相关性。肝移植前存在AF的受者的合并死亡OR为2.34（2项研究；95%CI：1.10-5.00）。此外，肝移植前存在的AF与肝移植受者术后心血管并发症相关（3项研究；OR：5.15，95%CI：2.67-9.92，P = 0.00064）。由于研究有限，两项研究表明新发AF与包括死亡、脑血管事件、移植后急性肾损伤以及肝移植受者移植失败风险增加在内的不良临床结局之间存在显著关联（P < 0.05）。
肝移植前存在的AF的总体估计患病率和肝移植后AF的发生率分别为5.4%和8.5%。肝移植后AF的发生率似乎并未随时间下降。肝移植前存在的AF和新发AF可能与肝移植后不良临床结局相关。
