Nomogram for predicting myocardial injury in pediatric patients undergoing living donor liver transplantation for biliary atresia

doi:10.4240/wjgs.v17.i4.103263

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World Journal of Gastrointestinal Surgery

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World J Gastrointest Surg. Apr 27, 2025; 17(4): 103263
Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.103263

Table 1 Demographic characteristics and outcomes, n (%)

	Total (n = 321)	Non-myocardial injury (n = 171)	Myocardial injury (n = 150)	P value
Preoperative clinical data
Age (month)	8.0 (6.0, 12.0)	9.0 (6.0, 16.5)	7.0 (6.0, 12.0)	0.002
Male gender	155 (48.3)	85 (49.7)	70 (46.7)	0.666
Weight (kg)	7.4 (6.5, 10.0)	7.9 (6.5, 11.0)	7.0 (6.5, 8.3)	0.003
Height (cm)	67 (63, 78)	70 (64, 82)	66 (63, 71)	0.002
QTc (ms)	405 (387, 423)	404 (387, 423)	406 (387, 430)	0.483
LVEF (%)	64 (62, 67)	64 (62, 66)	65 (62, 67)	0.254
NLR	0.78 (0.50, 1.29)	0.56 (0.42, 0.96)	1.10 (0.74, 1.88)	< 0.001
PLR	39.5 (28.2, 55.2)	38.4 (27.4, 51.0)	40.7 (28.9, 57.6)	0.067
hsCRP (mg/L)	5.31 (2.26, 12.78)	3.36 (0.92, 7.19)	9.66 (5.09, 26.43)	< 0.001
Albumin (g/L)	34.3 (32.0, 38.3)	35.0 (32.9, 39.5)	33.6 (31.0, 36.5)	0.001
TB (μmol/L)	225 (77, 317)	172 (39, 278)	258 (153, 352)	< 0.001
AST (U/L)	190 (119, 303)	191(113, 330)	186 (124, 290)	0.656
ALT (U/L)	113 (71, 174)	119 (65, 197)	110 (74, 153)	0.565
Creatinine (μmol/L)	13.0 (11.0, 16.0)	14.0 (12.0, 16.0)	12.0 (10.0, 15.0)	0.017
Hemoglobin (g/L), mean ± SD	93 ± 16	95 ± 17	90 ± 15	0.011
Platelet (10⁹/L)	190 (127, 255)	190 (126, 235)	190 (130, 262)	0.378
INR	1.38 (1.13, 1.82)	1.25 (1.06, 1.66)	1.54 (1.32, 1.92)	< 0.001
PELD				< 0.001
< 14.5	103 (32.1)	82 (48.0)	21 (14.0)
≥ 14.5	218 (67.9)	89 (52.0)	129 (86.0)
Graft-related data
Graft Weight (g)	244 (214, 280)	246 (214, 277)	244 (217, 280)	0.814
Graft CIT (minute)	86 (66, 112)	85 (66, 109)	86 (67, 115)	0.275
Intraoperative clinical data
Laboratory test results before reperfusion
pH, mean ± SD	7.388 ± 0.067	7.391 ± 0.068	7.384 ± 0.067	0.379
Base excess (mmol/L)	-4.40 (-6.40, -2.40)	-4.40 (-6.25, -1.90)	-4.40 (-6.65, -3.00)	0.338
Lactate (mmol/L)	2.60 (2.10, 3.40)	2.50 (1.90, 3.10)	2.70 (2.20, 3.70)	0.001
Hemoglobin (g/L)	82 (73, 92)	84 (75, 93)	81 (73, 91)	0.219
K (mmol/L)	3.70 (3.40, 4.10)	3.70 (3.50, 4.20)	3.70 (3.40, 4.07)	0.405
Ca (mmol/L)	1.09 (1.01, 1.16)	1.09 (1.01, 1.16)	1.08 (1.01, 1.16)	0.827
Vital signs before reperfusion
Heart rate (beats/minute), mean ± SD	117 ± 13	119 ± 14	115 ± 12	0.029
MAP (mmHg)	58 (52, 66)	59 (54, 67)	56 (51, 64)	0.014
CVP (mmHg)	5 (3, 7)	5 (4, 7)	5 (3, 7)	0.821
Temperature (°C)	36.5 (35.9, 37.0)	36.5 (35.9, 37.0)	36.5 (35.8, 37.0)	0.528
Anhepatic phase time (minute)	48 (41, 58)	48 (40, 56)	49 (41, 62)	0.141
PRS				< 0.001
No	182 (56.7)	124 (72.5)	58 (38.7)
Yes	139 (43.3)	47 (27.5)	92 (61.3)
Data at the end of surgery
Blood loss (mL)	300 (200, 400)	300 (200, 400)	300 (200, 400)	0.415
RBCs transfusion (units)	2.0 (2.0, 3.0)	2.0 (1.5, 3.0)	2.0 (2.0, 3.0)	0.069
FFP infusion (mL)	0 (0, 150)	0 (0, 100)	0 (0, 200)	0.005
Fluid infusion (mL)	1387 (1100, 1700)	1387 (1100, 1770)	1384 (1103, 1671)	0.784
Urine volume (mL)	400 (280, 600)	400 (300, 600)	400 (240, 600)	0.120
Surgical time (minute)	540 (490, 600)	540 (495, 600)	542 (481, 590)	0.730
Anaesthesia time (minute)	615 (560, 650)	615 (565, 650)	616 (555, 655)	0.650
Postoperative clinical data
Ventilation time (minute)	205 (136, 340)	230 (147, 349)	185 (133, 320)	0.193
ICU stay (day)	2.5 (2.0, 3.0)	2.0 (2.0, 3.0)	3.0 (2.0, 3.4)	0.044
AKI				0.545
No	240 (74.8)	125 (73.1)	115 (76.7)
Yes	81 (25.2)	46 (26.9)	35 (23.3)
Liver function tests during the initial week following LDLT
Peak TB (μmol/L)	84 (56, 117)	78 (50, 115)	92 (66, 123)	0.004
Peak AST (U/L)	697 (485, 1290)	666 (448, 1180)	758 (506, 1395)	0.027
Peak ALT (U/L)	586 (404, 1089)	585 (372, 1076)	592 (415, 1138)	0.247
Hospital stay (day)	21 (17, 27)	21 (17, 30)	21 (17, 25)	0.158
1-year survival rate	306 (95.3)	168 (98.2)	138 (92.0)	0.017

LVEF: Left ventricular ejection fraction; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; hsCRP: High sensitivity C-reactive protein; TB: Total bilirubin; AST: Aspartate transaminase; ALT: Alanine transaminase; INR: International normalized ratio; PELD: Pediatric end-stage liver disease; CIT: Cold ischemia time; MAP: Mean arterial pressure; CVP: Central venous pressure; PRS: Postreperfusion syndrome; RBC: Red blood cell; FFP: Fresh frozen plasma; ICU: Intensive care unit; AKI: Acute kidney injury; LDLT: Living donor liver transplantation.

Citation: Wu YL, Jing YL, Liu WH, Gong XY, Che L, Xue JY, Li TY, Jiang L, Huang XY, Yu WL, Weng YQ. Nomogram for predicting myocardial injury in pediatric patients undergoing living donor liver transplantation for biliary atresia. World J Gastrointest Surg 2025; 17(4): 103263
URL: https://www.wjgnet.com/1948-9366/full/v17/i4/103263.htm
DOI: https://dx.doi.org/10.4240/wjgs.v17.i4.103263