Department of Critical Care Medicine, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Clin Transplant. 2021 Nov;35(11):e14463. doi: 10.1111/ctr.14463. Epub 2021 Sep 23.
Takotsubo syndrome (TTS) can develop after liver transplant (LT), but its predisposing factors are poorly understood. In this study, we aimed to determine if perioperative factors were associated with posttransplant TTS. Adult patients who underwent primary LT between 2006 and 2018 were included. Patients with and without TTS were identified and matched by propensity scores. Of 2181 LT patients, 38 developed postoperative TTS with a mean left ventricular ejection fraction of 25.5% (±7.8%). Multivariable logistic regression revealed two preoperative risk factors (alcoholic cirrhosis and model for end-stage liver disease-sodium scores) for TTS. Post-propensity match analyses showed that TTS patients had significantly higher doses of epinephrine and lower doses of fentanyl during LT compared with non-TTS patients. A higher dose of epinephrine and a lower dose of fentanyl was associated with a higher predicted probability of TTS. All TTS patients had full recovery of cardiac function and had comparable 1-year survival. In conclusion, TTS occurred at a rate of 1.7% after LT and was associated with two pretransplant risk factors. The higher doses of epinephrine and lower doses of fentanyl administered during LT were associated with posttransplant TTS. More studies on the relationship between intraoperative medications and TTS are warranted.
心脏骤停后心肌病（TTS）可在肝移植（LT）后发生，但其易患因素知之甚少。本研究旨在确定围手术期因素是否与移植后 TTS 相关。纳入 2006 年至 2018 年间接受原发性 LT 的成年患者。根据倾向评分确定 TTS 患者和无 TTS 患者，并进行匹配。在 2181 例 LT 患者中，38 例患者术后发生 TTS，左心室射血分数平均为 25.5%（±7.8%）。多变量逻辑回归显示 TTS 的两个术前危险因素（酒精性肝硬化和终末期肝病模型钠评分）。倾向性匹配后分析显示，与非 TTS 患者相比，TTS 患者在 LT 期间接受的肾上腺素剂量明显更高，芬太尼剂量明显更低。较高剂量的肾上腺素和较低剂量的芬太尼与 TTS 的预测概率较高相关。所有 TTS 患者的心脏功能均完全恢复，1 年生存率相当。总之，LT 后 TTS 的发生率为 1.7%，与 2 个移植前危险因素相关。LT 期间给予的较高剂量肾上腺素和较低剂量芬太尼与移植后 TTS 相关。需要进行更多关于术中药物与 TTS 之间关系的研究。
