Postoperative Atrial Fibrillation and Flutter in Liver Transplantation: An Important Predictor of Early and Late Morbidity and Mortality

Rayan Jo Rachwan, Issa Kutkut, Taylor J. Hathaway, Lava R. Timsina, Chandrashekhar A. Kubal, Marco A. Lacerda, Marwan S. Ghabril, Patrick D. Bourdillon, Richard S. Mangus

Research output: Contribution to journalArticle

Abstract

Postoperative atrial fibrillation/flutter (POAF) is the most common perioperative arrhythmia and may be particularly problematic after liver transplantation (LT). This study is a single-center retrospective analysis of POAF to determine its incidence following LT, to identify risk factors, to assess its impact on clinical outcomes, and to summarize management strategies. The records of all patients who underwent LT between 2010 and 2018 were reviewed. Extracted data included pre-LT demographics and cardiac evaluation, in-hospital post-LT cardiac events, early and late complications, and survival. Among 1011 patients, the incidence of post-LT POAF was 10%. Using binary logistic regression, pre-LT history of atrial fibrillation was the strongest predictor of POAF (odds ratio [OR], 6.72; 95% confidence interval [CI], 2.00-22.57; P < 0.001), followed by history of coronary artery disease (CAD; OR, 2.52; 95% CI, 1.10-5.81; P = 0.03). Cardiac stress testing abnormality and CAD on cardiac catheterization were also associated with higher risk. Median time to POAF onset after LT was 3 days with 72% of cases resolving within 48 hours. POAF patients had greater hospital length of stay, death during the LT admission, and 90-day and 1-year mortality. POAF was an independent risk factor for post-LT mortality (OR, 2.0; 95% CI, 1.3-3.0; P < 0.01). Amiodarone was administered to 73% of POAF patients with no evidence of increased serum alanine aminotransferase levels. POAF occurred in 10% of post-LT patients with early onset and rapid resolution in most affected patients. POAF patients, however, had significant morbidity and mortality, suggesting that POAF is an important marker for worse early and late post-LT outcomes.

Original languageEnglish (US)
JournalLiver Transplantation
DOIs
StateAccepted/In press - Jan 1 2019

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Atrial Flutter
Liver Transplantation
Atrial Fibrillation
Morbidity
Mortality
Odds Ratio
Confidence Intervals
Length of Stay
Amiodarone
Incidence
Cardiac Catheterization
Alanine Transaminase
Cardiac Arrhythmias
Coronary Artery Disease
Logistic Models

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Postoperative Atrial Fibrillation and Flutter in Liver Transplantation : An Important Predictor of Early and Late Morbidity and Mortality. / Rachwan, Rayan Jo; Kutkut, Issa; Hathaway, Taylor J.; Timsina, Lava R.; Kubal, Chandrashekhar A.; Lacerda, Marco A.; Ghabril, Marwan S.; Bourdillon, Patrick D.; Mangus, Richard S.

In: Liver Transplantation, 01.01.2019.

Research output: Contribution to journalArticle

Rachwan, Rayan Jo ; Kutkut, Issa ; Hathaway, Taylor J. ; Timsina, Lava R. ; Kubal, Chandrashekhar A. ; Lacerda, Marco A. ; Ghabril, Marwan S. ; Bourdillon, Patrick D. ; Mangus, Richard S. / Postoperative Atrial Fibrillation and Flutter in Liver Transplantation : An Important Predictor of Early and Late Morbidity and Mortality. In: Liver Transplantation. 2019.
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abstract = "Postoperative atrial fibrillation/flutter (POAF) is the most common perioperative arrhythmia and may be particularly problematic after liver transplantation (LT). This study is a single-center retrospective analysis of POAF to determine its incidence following LT, to identify risk factors, to assess its impact on clinical outcomes, and to summarize management strategies. The records of all patients who underwent LT between 2010 and 2018 were reviewed. Extracted data included pre-LT demographics and cardiac evaluation, in-hospital post-LT cardiac events, early and late complications, and survival. Among 1011 patients, the incidence of post-LT POAF was 10{\%}. Using binary logistic regression, pre-LT history of atrial fibrillation was the strongest predictor of POAF (odds ratio [OR], 6.72; 95{\%} confidence interval [CI], 2.00-22.57; P < 0.001), followed by history of coronary artery disease (CAD; OR, 2.52; 95{\%} CI, 1.10-5.81; P = 0.03). Cardiac stress testing abnormality and CAD on cardiac catheterization were also associated with higher risk. Median time to POAF onset after LT was 3 days with 72{\%} of cases resolving within 48 hours. POAF patients had greater hospital length of stay, death during the LT admission, and 90-day and 1-year mortality. POAF was an independent risk factor for post-LT mortality (OR, 2.0; 95{\%} CI, 1.3-3.0; P < 0.01). Amiodarone was administered to 73{\%} of POAF patients with no evidence of increased serum alanine aminotransferase levels. POAF occurred in 10{\%} of post-LT patients with early onset and rapid resolution in most affected patients. POAF patients, however, had significant morbidity and mortality, suggesting that POAF is an important marker for worse early and late post-LT outcomes.",
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AU - Rachwan, Rayan Jo

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AU - Timsina, Lava R.

AU - Kubal, Chandrashekhar A.

AU - Lacerda, Marco A.

AU - Ghabril, Marwan S.

AU - Bourdillon, Patrick D.

AU - Mangus, Richard S.

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AB - Postoperative atrial fibrillation/flutter (POAF) is the most common perioperative arrhythmia and may be particularly problematic after liver transplantation (LT). This study is a single-center retrospective analysis of POAF to determine its incidence following LT, to identify risk factors, to assess its impact on clinical outcomes, and to summarize management strategies. The records of all patients who underwent LT between 2010 and 2018 were reviewed. Extracted data included pre-LT demographics and cardiac evaluation, in-hospital post-LT cardiac events, early and late complications, and survival. Among 1011 patients, the incidence of post-LT POAF was 10%. Using binary logistic regression, pre-LT history of atrial fibrillation was the strongest predictor of POAF (odds ratio [OR], 6.72; 95% confidence interval [CI], 2.00-22.57; P < 0.001), followed by history of coronary artery disease (CAD; OR, 2.52; 95% CI, 1.10-5.81; P = 0.03). Cardiac stress testing abnormality and CAD on cardiac catheterization were also associated with higher risk. Median time to POAF onset after LT was 3 days with 72% of cases resolving within 48 hours. POAF patients had greater hospital length of stay, death during the LT admission, and 90-day and 1-year mortality. POAF was an independent risk factor for post-LT mortality (OR, 2.0; 95% CI, 1.3-3.0; P < 0.01). Amiodarone was administered to 73% of POAF patients with no evidence of increased serum alanine aminotransferase levels. POAF occurred in 10% of post-LT patients with early onset and rapid resolution in most affected patients. POAF patients, however, had significant morbidity and mortality, suggesting that POAF is an important marker for worse early and late post-LT outcomes.

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