Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2023; 15(9): 2021-2031
Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.2021
Risk factors for myocardial injury during living donor liver transplantation in pediatric patients with biliary atresia
Yu-Li Wu, Tian-Ying Li, Xin-Yuan Gong, Lu Che, Ming-Wei Sheng, Wen-Li Yu, Yi-Qi Weng
Yu-Li Wu, The First Central Clinical School, Tianjin Medical University, Tianjin 300192, China
Tian-Ying Li, School of Medicine, Nankai University, Tianjin 300071, China
Xin-Yuan Gong, Department of Science and Education, Tianjin First Central Hospital, Tianjin 300192, China
Lu Che, Ming-Wei Sheng, Wen-Li Yu, Yi-Qi Weng, Department of Anesthesiology, Tianjin First Central Hospital, Tianjin 300192, China
Author contributions: Wu YL and Weng YQ helped to write the manuscript; Li TY and Che L coordinated and supervised data collection; Gong XY performed the statistical analysis; Wu YL and Li TY created the tables and figures. Sheng MW revised the manuscript in detail; Weng YQ and Yu WL critically reviewed the manuscript for important intellectual content; Both Weng YQ and Yu WL were responsible for the study and contributed equally to this manuscript; all authors have read and agreed to the publication of the manuscript.
Supported by Science and Technology Foundation of Tianjin Health Bureau, No. ZC20052; Tianjin Key Medical Discipline (Specialty) Construction Project, No. TJYXZDXK-045A; Tianjin Anesthesia Research Development Program of Bethune Charitable Foundation, No. TJMZ2022-005; Natural Science Foundation of Tianjin, No. 21JCQNJC01730; and Young Talent Program of Tianjin First Central Hospital.
Institutional review board statement: The study was reviewed and approved by the ethics committee of the Tianjin First Central Hospital, No. 2022DZX02.
Informed consent statement: Informed consent was waived by the local ethics committee, given the study's retrospective nature.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Qi Weng, Doctor, PhD, Chief Physician, Professor, Department of Anesthesiology, Tianjin First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. wyq2023@nankai.edu.cn
Received: June 23, 2023
Peer-review started: June 23, 2023
First decision: July 4, 2023
Revised: July 10, 2023
Accepted: July 27, 2023
Article in press: July 27, 2023
Published online: September 27, 2023
Processing time: 91 Days and 0.4 Hours
Abstract
BACKGROUND

Cold ischemia-reperfusion of the liver is an inevitable occurrence in liver transplantation that may also cause damage to the heart. Perioperative myocardial injury during liver transplantation can increase the incidence of postoperative mortality, but there is little research on the incidence of myocardial injury in children who undergo living donor liver transplantation (LDLT). Therefore, this study mainly explores the independent risk factors for myocardial injury in children who undergo LDLT.

AIM

To analyze the data of children who underwent LDLT to determine the risk factors for intraoperative myocardial injury.

METHODS

We retrospectively analyzed the inpatient records of pediatric patients who underwent LDLT in Tianjin First Central Hospital from January 1, 2020, to January 31, 2022. Recipient-related data and donor-related data were collected. The patients were divided into a myocardial injury group and a nonmyocardial injury group according to the value of the serum cardiac troponin I at the end of surgery for analysis. Univariate analysis and multivariate logistic regression were used to evaluate the risk factors for myocardial injury during LDLT in pediatric patients.

RESULTS

A total of 302 patients met the inclusion criteria. The myocardial injury group had 142 individuals (47%), and the nonmyocardial injury group included 160 patients (53%). Age, height, and weight were significantly lower in the myocardial injury group (P < 0.001). The pediatric end-stage liver disease (PELD) score, total bilirubin, and international standardized ratio were significantly higher in the myocardial injury group (P < 0.001). The mean arterial pressure, lactate, hemoglobin before reperfusion, duration of the anhepatic phase, cold ischemic time, incidence of postreperfusion syndrome (PRS), and fresh frozen plasma transfusion were significantly different between the two groups (P < 0.05). The postoperative intensive care unit stay and peak total bilirubin values in the first 5 d after LDLT were significantly higher in the myocardial injury group (P < 0.05). The pediatric patients with biliary atresia in the nonmyocardial injury group who underwent LDLT had a considerably higher one-year survival rate than those in the myocardial injury group (P = 0.015). Multivariate logistic regression revealed the following independent risk factors for myocardial injury: a high PELD score [odds ratio (OR) = 1.065, 95% confidence interval (CI): 1.013-1.121; P = 0.014], a long duration of the anhepatic phase (OR = 1.021, 95%CI: 1.003-1.040; P = 0.025), and the occurrence of intraoperative PRS (OR = 1.966, 95%CI: 1.111-3.480; P = 0.020).

CONCLUSION

A high PELD score, a long anhepatic phase duration, and the occurrence of intraoperative PRS were independent risk factors for myocardial injury during LDLT in pediatric patients with biliary atresia.

Keywords: Heart injuries, Child, Liver transplantation, Reperfusion injury, Prognosis

Core Tip: This is a retrospective study to investigate data for children who underwent living donor liver transplantation to determine risk factors for intraoperative myocardial injury. Myocardial injury during liver transplantation is associated with postoperative adverse outcomes in pediatric patients; it can increase the incidence of postoperative mortality. Our findings demonstrated that a high pediatric end-stage liver disease score, a long anhepatic phase duration, and the occurrence of intraoperative postreperfusion syndrome are independent risk factors for myocardial injury.