Department of Cardiology, Austin Health, Melbourne, VIC, Australia.
The University of Melbourne, Parkville, VIC, Australia.
Transplantation. 2021 Mar 1;105(3):593-601. doi: 10.1097/TP.0000000000003306.
Hepatorenal syndrome (HRS) is a serious complication of liver cirrhosis with poor survival in the absence of liver transplantation (LT). HRS represents a state of profound circulatory and cardiac dysfunction. Whether it increases risk of perioperative major adverse cardiovascular events (MACE) following LT remains unclear.
We performed a retrospective cohort study of 560 consecutive patients undergoing cardiac workup for LT of whom 319 proceeded to LT. All patients underwent standardized assessment including dobutamine stress echocardiography. HRS was defined according to International Club of Ascites criteria.
Primary outcome of 30-day MACE occurred in 74 (23.2%) patients. A significantly higher proportion of patients with HRS experienced MACE (31 [41.9%] versus 54 [22.0%]; P = 0.001). After adjusting for age, model for end-stage liver disease score, cardiovascular risk index, history of coronary artery disease, and a positive stress test, HRS remained an independent predictor for MACE (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.13-5.78). Other independent predictors included poor functional status (OR, 3.38; 95% CI, 1.41-8.13), pulmonary hypertension (OR, 3.26; 95% CI, 1.17-5.56), and beta-blocker use (OR, 2.56; 95% CI, 1.10-6.48). Occurrence of perioperative MACE was associated with a trend toward poor age-adjusted survival over 3.6-year follow-up (hazard ratio, 2.0; 95% CI, 0.98-4.10; P = 0.057).
HRS, beta-blocker use, pulmonary hypertension, and poor functional status were all associated with over a 2-fold higher risk of MACE following LT. Whether inclusion of these variables in routine preoperative assessment can facilitate cardiac risk stratification warrants further study.
肝肾综合征（HRS）是肝硬化的严重并发症，在没有肝移植（LT）的情况下，患者生存率较差。HRS 代表一种严重的循环和心脏功能障碍状态。它是否会增加 LT 后围手术期主要不良心血管事件（MACE）的风险尚不清楚。
我们对 560 例连续接受 LT 心脏检查的患者进行了回顾性队列研究，其中 319 例患者接受了 LT。所有患者均接受了标准化评估，包括多巴酚丁胺负荷超声心动图。HRS 根据国际腹水俱乐部标准定义。
30 天内 MACE 的主要结局发生在 74 例（23.2%）患者中。HRS 患者发生 MACE 的比例明显更高（31 例[41.9%]与 54 例[22.0%]；P = 0.001）。在校正年龄、终末期肝病模型评分、心血管风险指数、冠心病史和阳性应激试验后，HRS 仍然是 MACE 的独立预测因素（比值比[OR]，2.44；95%置信区间[CI]，1.13-5.78）。其他独立预测因素包括功能状态差（OR，3.38；95% CI，1.41-8.13）、肺动脉高压（OR，3.26；95% CI，1.17-5.56）和β受体阻滞剂的使用（OR，2.56；95% CI，1.10-6.48）。围手术期 MACE 的发生与 3.6 年随访期间年龄调整生存率降低趋势相关（风险比，2.0；95% CI，0.98-4.10；P = 0.057）。
HRS、β受体阻滞剂的使用、肺动脉高压和功能状态差均与 LT 后 MACE 的风险增加 2 倍以上相关。在常规术前评估中纳入这些变量是否可以促进心脏风险分层值得进一步研究。
