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
ARTICLE HIGHLIGHTS
Research background

Myocardial injury during liver transplantation is associated with postoperative adverse outcomes in pediatric patients; it can increase the incidence of postoperative mortality.

Research motivation

For a long time, research on myocardial injury has mainly focused on adults, but there is relatively little information on myocardial injury in children who have undergone living donor liver transplantation (LDLT).

Research objectives

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

Research 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.

Research 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%). 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 (98.1% vs 92.3%, P = 0.015). Multivariate logistic regression revealed the following independent risk factors for myocardial injury: a high pediatric end-stage liver disease (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 postreperfusion syndrome (PRS) (OR = 1.966, 95%CI: 1.111-3.480; P = 0.020).

Research conclusions

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.

Research perspectives

This study’s sample size is very large, and thus far, there has been no retrospective study with a large sample size that has been conducted to evaluate the risk factors for intraoperative myocardial injury in children who are subjected to LDLT, which may be the advantage of this study. But different centers have different anesthetic management strategies, and the results of a single-center study may be biased, thus requiring multicenter large sample data for analysis in the future.