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. 2022 Aug:41:154-158.
doi: 10.1016/j.carrev.2022.03.012. Epub 2022 Mar 15.

Postoperative Myocardial Injury and Outcomes in Liver and Kidney Transplant Patients

Michael Yang  1 , Syed Z Qamer  1 , Andrew P Hill  2 , Brian C Case  3 , Alexander J Gilbert  4 , Rohit S Satoskar  5 , Alexander T Lalos  5 , Carolina Valdiviezo  3 , Toby Rogers  6 , Lowell F Satler  3 , Ron Waksman  3 , Itsik Ben-Dor  7
Affiliations

Postoperative Myocardial Injury and Outcomes in Liver and Kidney Transplant Patients

Michael Yang et al. Cardiovasc Revasc Med. 2022 Aug.

Abstract

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.

Results: 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).

Conclusions: 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.

Keywords: MINS; Post-operative MACE; Pre-operative testing.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Ron Waksman – Advisory Board: Abbott Vascular, Boston Scientific, Medtronic, Philips IGT, Pi-Cardia Ltd.; Consultant: Abbott Vascular, Biotronik, Boston Scientific, Cordis, Medtronic, Philips IGT, Pi-Cardia Ltd., Swiss Interventional Systems/SIS Medical AG, Transmural Systems Inc., Venous MedTech; Grant Support: AstraZeneca, Biotronik, Boston Scientific, Chiesi, Medtronic, Philips IGT; Speakers Bureau: AstraZeneca; Investor: MedAlliance, Transmural Systems Inc. All other authors – None.

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