Meta-Analysis
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2018; 10(10): 761-771
Published online Oct 27, 2018. doi: 10.4254/wjh.v10.i10.761
Liver transplantation and atrial fibrillation: A meta-analysis
Ronpichai Chokesuwattanaskul, Charat Thongprayoon, Tarun Bathini, Patompong Ungprasert, Konika Sharma, Karn Wijarnpreecha, Pavida Pachariyanon, Wisit Cheungpasitporn
Ronpichai Chokesuwattanaskul, Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
Charat Thongprayoon, Tarun Bathini, Konika Sharma, Karn Wijarnpreecha, Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, United States
Patompong Ungprasert, Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Pavida Pachariyanon, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
Wisit Cheungpasitporn, Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, United States
Author contributions: Chokesuwattanaskul R and Thongprayoon C contributed to acquisition of data, analysis and interpretation of data, drafting the articles, final approval; Bathini T and Sharma K contributed to acquisition of data, drafting the articles, final approval; Wijarnpreecha K and Ungprasert P contributed to interpretation the data, revising the article, final approval; Pachariyanon P contributed to interpretation the data, revising the article, final approval; Cheungpasitporn W contributed to conception and design of the study, critical revision, final approval.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wisit Cheungpasitporn, MD, Assistant Professor, Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS 39216, United States. wcheungpasitporn@gmail.com
Telephone: +1-601-9845670 Fax: +1-601-9845765
Received: May 2, 2018
Peer-review started: May 3, 2018
First decision: May 17, 2018
Revised: June 24, 2018
Accepted: June 28, 2018
Article in press: June 29, 2018
Published online: October 27, 2018
Processing time: 179 Days and 17.6 Hours
Abstract
AIM

To assess prevalence of pre-existing atrial fibrillation (AF) and/or incidence of AF following liver transplantation, and the trends of patient’s outcomes overtime; to evaluate impact of pre-existing AF and post-operative AF on patient outcomes following liver transplantation.

METHODS

A literature search was conducted utilizing MEDLINE, EMBASE and Cochrane Database from inception through March 2018. We included studies that reported: (1) prevalence of pre-existing AF or incidence of AF following liver transplantation; or (2) outcomes of liver transplant recipients with AF. Effect estimates from the individual study were extracted and combined utilizing random-effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews, No. CRD42018093644).

RESULTS

Twelve observational studies with a total of 38586 liver transplant patients were enrolled. Overall, the pooled estimated prevalence of pre-existing AF in patients undergoing liver transplantation was 5.4% (95%CI: 4.9%-5.9%) and pooled estimated incidence of AF following liver transplantation was 8.5% (95%CI: 5.2%-13.6%). Meta-regression analyses were performed and showed no significant correlations between year of study and either prevalence of pre-existing AF (P = 0.08) or post-operative AF after liver transplantation (P = 0.54). The pooled OR of mortality among liver transplant recipients with pre-existing AF was 2.34 (2 studies; 95%CI: 1.10-5.00). In addition, pre-existing AF is associated with postoperative cardiovascular complications among liver transplant recipients (3 studies; OR: 5.15, 95%CI: 2.67-9.92, I2 = 64%). With limited studies, two studies suggested significant association between new-onset AF and poor clinical outcomes including mortality, cerebrovascular events, post-transplant acute kidney injury, and increased risk of graft failure among liver transplant recipients (P < 0.05).

CONCLUSION

The overall estimated prevalence of pre-existing AF and incidence of AF following liver transplantation are 5.4% and 8.5%, respectively. Incidence of AF following liver transplant does not seem to decrease overtime. Pre-existing AF and new-onset AF are potentially associated with poor clinical outcomes post liver transplantation.

Keywords: Atrial fibrillation; Liver; Hepatic; Transplant; Transplantation; Systematic reviews; Meta-analysis

Core tip: Atrial fibrillation (AF) occurs in a substantial number of postoperative and post-transplantation patients. In addition, postoperative AF confers both short-term and long-term morbidity and mortality in liver transplant patients. However, the incidence of postoperative AF in patients undergoing liver transplantation and its impacts remain unclear. To further investigate, we conducted a meta-analysis to assess the rates of preexisting AF and AF following liver transplantation as well as the outcomes of liver transplant patients with AF. Incidence of AF following liver transplant does not seem to decrease overtime. Pre-existing AF and new-onset AF are potentially associated with poor clinical outcomes post liver transplantation.