Canbolat Ismail Polat, Adali Gupse, Akdeniz Cansu Selcan, Bozkurt Birkan, Ferah Oya, Bulutcu Fisun, Yuzer Yildiray, Tokat Yaman
Department of Cardiology, Istanbul Bilim University Faculty of Medicine, Istanbul, Turkey.
Department of Gastroenterohepatology, Istanbul Bilim University Faculty of Medicine, Istanbul, Turkey.
Transplant Proc. 2019 Sep;51(7):2478-2481. doi: 10.1016/j.transproceed.2019.02.046.
Preoperative cardiac troponin-I (cTnI) elevation has been shown to be a predictor of mortality after liver transplantation. Myocardial injury after non-cardiac surgery (MINS) has been defined as elevation of serum cardiac troponin levels in the perioperative period that does not fulfill the criteria for myocardial infarction. MINS has been shown to be a prognostic factor for in-hospital and long-term mortality, but there is limited data in patients undergoing living-donor liver transplantation (LDLT). In this study, we aimed to evaluate the relationship between MINS and postoperative mortality.
Patients who had undergone adult LDLT at Florence Nightingale Hospital Liver Transplantation Unit between December 2012 and December 2015 were retrospectively analyzed for 30-day in-hospital and 1-year mortality. Myocardial injury was defined as cTnI level above 0.04 ng/mL. Patients (N = 214) were divided into 2 groups according to postoperative cTnI levels. The following were the exclusion criteria: 1. patients under 18 years old, 2. patients undergoing deceased-donor liver transplantation or dual liver-kidney transplantation, 3. cTnI elevation due to other causes (sepsis, renal failure, pulmonary embolism, myocardial infarction), and 4. patients without postoperative troponin levels.
MINS occurred in 123 (57.4%) patients after LDLT. There was no difference between the groups according to age, sex, creatinine levels, presence of ischemic heart disease, hypertension, diabetes mellitus, and tobacco use. The presence of MINS did not predict 30-day and 1-year mortality in the study population.
Myocardial injury detected by serum cTnI elevation was frequent after LDLT; however, it was not associated with 30-day in-hospital and 1-year mortality.
术前心肌肌钙蛋白I（cTnI）升高已被证明是肝移植术后死亡率的预测指标。非心脏手术术后心肌损伤（MINS）被定义为围手术期血清心肌肌钙蛋白水平升高，但不符合心肌梗死的标准。MINS已被证明是住院和长期死亡率的预后因素，但在活体肝移植（LDLT）患者中的数据有限。在本研究中，我们旨在评估MINS与术后死亡率之间的关系。
回顾性分析2012年12月至2015年12月在佛罗伦萨南丁格尔医院肝移植科接受成人LDLT的患者的30天住院死亡率和1年死亡率。心肌损伤定义为cTnI水平高于0.04 ng/mL。根据术后cTnI水平将214例患者分为两组。排除标准如下：1. 18岁以下患者；2. 接受尸体供肝肝移植或肝肾联合移植的患者；3. 由其他原因（脓毒症、肾衰竭、肺栓塞、心肌梗死）导致的cTnI升高；4. 术后未检测肌钙蛋白水平的患者。
LDLT术后123例（57.4%）患者发生MINS。两组在年龄、性别、肌酐水平、缺血性心脏病、高血压、糖尿病和吸烟情况方面无差异。在研究人群中，MINS的存在并不能预测30天和1年死亡率。
LDLT术后血清cTnI升高检测到的心肌损伤很常见；然而，它与30天住院死亡率和1年死亡率无关。
