Postoperative Atrial Fibrillation in Liver Transplantation

• Published in: American journal of transplantation Vol. 15; no. 3; pp. 687 - 694
• Main Authors: Xia, V. W., Worapot, A., Huang, S., Dhillon, A., Gudzenko, V., Backon, A., Agopian, V. G., Aksoy, O., Vorobiof, G., Busuttil, R. W., Steadman, R. H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01-03-2015
• Subjects: Adult; Atrial Fibrillation - etiology; Cardiac arrhythmia; cardiology; cardiovascular disease; clinical research; complication; critical care; Female; heart transplantation; hepatology; Humans; intensive care management; liver transplantation; Liver Transplantation - adverse effects; Male; Medical research; Middle Aged; Postoperative Complications; practice; Pulmonary arteries; Risk factors; cardiovascular disease; complication; practice; clinical research; heart transplantation; critical care; hepatology; intensive care management; cardiology; liver transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.13034

Postoperative atrial fibrillation (POAF) is common after major surgeries and is associated with increased morbidity and mortality. POAF after liver transplantation (LT) has not been reported. This study was undertaken to investigate the incidence, impact, and risk factors of POAF in LT patients. After IRB approval, LT between January 2006 and August 2013 at our center were retrospectively reviewed. POAF that occurred within 30 days after LT was included. Patients with and without POAF were compared and independent risk factors were identified by logistic regression. Of 1387 adults LT patients, 102 (7.4%) developed POAF during the study period. POAF was associated with significantly increased mortality, graft failure, acute kidney injury and prolonged hospital stay. Independent risk factors included age, body weight, MELD score, presence of previous history of AF, the vasopressors use prior to LT and pulmonary artery diastolic pressure at the end of LT surgery (odds ratios 2.0–7.2, all p < 0.05). A risk index of POAF was developed and patients with the high‐risk index had more than 60% chance of developing POAF. These findings may be used to stratify patients and to guide prophylaxis for POAF in the posttransplant period.
In adult liver transplantation, postoperative atrial fibrillation, occurring at a significant rate and being associated with poor outcomes, deserves preoperative stratification, close postoperative monitoring, and possible pharmacological prophylaxis.