Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.2021
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
Myocardial injury during liver transplantation is associated with postoperative adverse outcomes in pediatric patients; it can increase the incidence of postoperative mortality.
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).
To analyze the data of children who underwent LDLT to determine the risk factors for intraoperative myocardial injury.
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.
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).
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.
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.