MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, Washington, DC, United States of America; MedStar Georgetown University Hospital, Washington, DC, United States of America.
MedStar Georgetown University Hospital, Washington, DC, United States of America.
Cardiovasc Revasc Med. 2022 Aug;41:154-158. doi: 10.1016/j.carrev.2022.03.012. Epub 2022 Mar 15.
BACKGROUND/PURPOSE: Myocardial injury after noncardiac surgery (MINS) is associated with major adverse cardiac events (MACE), but its significance post-liver and post-kidney transplantation is not well-defined.
METHODS/MATERIALS: We retrospectively studied consecutive patients undergoing single-organ liver or kidney transplantation at a large tertiary transplant center. Liver and kidney transplant patients with troponins drawn within 30 days of transplantation were included. The primary exposure was MINS, defined as troponin elevation above the 99th percentile of the upper reference limit within 30 days of transplantation. The primary outcome was MACE, defined as death, myocardial infarction, revascularization, stroke, or heart failure hospitalization.
Overall, 112 patients were included: 58 (51.7%) were liver transplant recipients, and 54 (48.3%) were kidney transplant recipients. Patients with MINS were significantly older (mean age 59 vs. 54 years, p = 0.01) and more likely to have diabetes (35% vs. 17%, p = 0.03). Other baseline characteristics were similar. Sixteen patients (14.2%) developed MACE, including 11 (9.8%) with 1-year MACE. MINS patients were significantly more likely to develop 1-year MACE (adjusted hazard ratio, 10.4; 95% confidence interval, 1.8-198). Kaplan-Meier cumulative MACE was significantly higher in the MINS group (p = 0.03).
Liver and kidney transplant recipients with MINS are significantly more likely to develop 1-year MACE compared to those without MINS. Future prospective studies are needed to further delineate the cardiac risk and outcomes in transplanted patients.
背景/目的：非心脏手术后心肌损伤（MINS）与主要不良心脏事件（MACE）相关，但在肝移植和肾移植后其意义尚未明确。
方法/材料：我们对一家大型三级移植中心连续进行单器官肝或肾移植的患者进行了回顾性研究。纳入了在移植后 30 天内抽取肌钙蛋白的肝和肾移植患者。主要暴露因素为 MINS，定义为移植后 30 天内肌钙蛋白升高超过上限参考值的第 99 百分位。主要结局为 MACE，定义为死亡、心肌梗死、血运重建、卒中和心力衰竭住院。
共有 112 例患者纳入研究：58 例（51.7%）为肝移植受者，54 例（48.3%）为肾移植受者。MINS 患者年龄明显较大（平均年龄 59 岁比 54 岁，p = 0.01），且更可能患有糖尿病（35%比 17%，p = 0.03）。其他基线特征相似。16 例患者（14.2%）发生 MACE，其中 11 例（9.8%）在 1 年内发生 MACE。MINS 患者发生 1 年 MACE 的风险明显更高（调整后的危险比，10.4；95%置信区间，1.8-198）。MINS 组的 Kaplan-Meier 累积 MACE 明显更高（p = 0.03）。
与无 MINS 的患者相比，肝和肾移植受者发生 1 年 MACE 的风险明显更高。未来需要前瞻性研究进一步明确移植患者的心脏风险和结局。
