• Eva Rivas, Kazunari Sasaki, Chen Liang, Jiayi Wang, Cristiano Quintini, Kamal Maheshwari, Alparslan Turan, Maan Fares, and Jacek B Cywinski.
• Department of OUTCOMES RESEARCH, Cleveland Clinic, Cleveland, OH; Department of Anesthesia, Hospital Clinic of Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
• J. Cardiothorac. Vasc. Anesth. 2022 Nov 1; 36 (11): 410041074100-4107.

ObjectiveThe authors aimed to identify predictors of new-onset postoperative atrial fibrillation (POAF) during the initial 90 days following liver transplantation, and to assess the association between POAF in-hospital and 1-year mortality.DesignA retrospective cohort study.SettingAt a university hospital between 2005 and 2017.PatientsAdults without a history of preoperative atrial fibrillation who underwent orthotopicliver transplantation.Measurement And Main ResultsThe authors assessed the univariate association between new-onset of POAF in the postoperative period and each potential factor through a logistic regression model. Moreover, they explored predictors for POAF through stepwise selection. Finally, the authors assessed the relationship between POAF and in-hospital and 1-year mortality using logistic regression models, and whether the duration of atrial fibrillation was associated with in-hospital and 1-year mortality. Among 857 patients, 89 (10.4%) developed POAF. Using only preoperative variables, pulmonary hypertension, age, Model for End-Stage Liver Disease (MELD) score, and White race were identified as the most important predictors. Model discrimination was 0.75 (95% CI: 0.69-0.80), and incorporating intraoperative variables was 0.77 (95% CI: 0.72-0.82). In-hospital mortality was observed in 7.2% (6/83) of patients with new-onset of POAF, and in 2.8% (22/768) without, with confounder-adjusted odds ratio (OR) 1.00 (97.5% CI: 0.29,3.45; p = 0.996). One-year mortality was 22.4% (20/89) in patients who developed POAF and 8.3% (64/768) in patients who did not, confounder-adjusted OR 2.64 (97.5% CI: 1.35-5.16; p = 0.001). The duration of POAF did not affect long-term postoperative mortality.ConclusionPreoperative, mostly unmodifiable comorbidities are important risk factors for new-onset POAF after liver transplantation. The POAF was not associated with in-hospital mortality, but with increased 1-year mortality. Once developed, the duration of POAF did not affect long-term mortality after a liver transplant.Copyright © 2022 Elsevier Inc. All rights reserved.

21 keywords...

hide…