Retrospective Study
Copyright ©The Author(s) 2023.
World J Gastrointest Surg. Sep 27, 2023; 15(9): 2021-2031
Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.2021
Table 1 Preoperative recipient-related data
Variable
Non-myocardial injury (n = 160)
Myocardial injury (n = 142)
P value
Age (mo)9.5 (6.0-16.8)7.0 (6.0-11.0)< 0.001
Male gender (%)78 (48.8)72 (50.7)0.735
Height (cm)70 (65-82)65 (62-70)< 0.001
Weight (kg)8.0 (6.5-11.0)7.0 (6.0-8.0)< 0.001
LVEF (%)64 (62-67)65 (62-67)0.167
QTc(ms)404 (387-427)405 (384-424)0.596
PELD score14 (4-21)22 (15-28)< 0.001
ALT (U/L)106 (61-168)103 (70-172)0.494
AST (U/L)177 (103-319)196 (129-295)0.186
TB (µmol/L)166 (40-278)262 (157-349)< 0.001
INR1.29 (1.09-1.63)1.52 (1.23-2.04)< 0.001
Cr (µmol/L)14.0 (12.0-16.0)13.5 (10.0-16.0)0.528
Hemoglobin (g/L)93 ± 1793 ± 160.671
LVEF: Left ventricular ejection fraction; PELD: Pediatric end-stage liver disease; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TB: Total bilirubin; INR: International normalized ratio; Cr: Creatinine.
Table 2 Intraoperative recipient-related data and donor-related data
Variable
Non-myocardial injury (n = 160)
Myocardial injury (n = 142)
P value
Vital signs immediately before reperfusion
    HR (bpm/min)118 ± 13117±130.515
    MAP (mmHg)60 (54-67)56 (51-62)0.001
    CVP (mmHg)5 (4-7)5 (3-7)0.454
    Temperature (°C)36.5 (35.9-37.0)36.5 (35.8-37.0)0.652
Laboratory findings before reperfusion
    pH7.39 ± 0.077.39 ± 0.070.952
    PCO2 (mmHg)34 (30-39)33 (30-38)0.148
    PO2 (mmHg)257 (176-309)242 (170-312)0.472
    Lactate (mmol/L)2.5 (1.8-3.2)2.7 (2.2-3.8)0.002
    Base excess (mmol/L)-4.2 (-6.5--1.7)-4.8 (-6.8--3.1)0.102
    Ca (mmol/L)1.08 (1.01-1.17)1.09 (1.00-1.15)0.648
    K (mmol/L)3.8±0.63.8±0.50.448
    Hemoglobin (g/L)84 (75-93)81 (72-91)0.038
Duration of anhepatic phase (min)56 (47-67)62 (50-76)0.019
Donor-related data
    Cold ischemic time (min)80 (64-106)90 (71-111)0.023
    Graft weight (g)244 (217-277)243 (208-278)0.654
PRS (%)54 (33.8)76 (53.5)0.001
The data at the end of the surgery
    Duration of surgery (min)542 (495-600)540 (484-593)0.814
    Duration of anesthesia (min)616 (555-651)610 (559-650)0.984
    Blood loss (mL)300 (200-400)350 (200-400)0.378
    Urine output (mL)400 (300-600)400 (248-600)0.909
    RBCs transfusion (units)2.0 (1.5-3.0)2.0 (2.0-3.0)0.078
    FFP transfusion (mL)0 (0-100)0 (0-200)0.009
HR: Heart rate; MAP: Mean arterial pressure; CVP: Central venous pressure; PRS: Postreperfusion syndrome; RBCs: Red blood cells; FFP: Fresh frozen plasma.
Table 3 Postoperative recipient-related data
Variable
Non-myocardial injury (n = 160)
Myocardial injury (n =142)
P value
Ventilation time (min)220 (129-351)196 (146-321)0.785
ICU stay (d)2 (2.0-3.0)3 (2.0-3.5)0.041
hospital stay (d)20 (16-29)21 (17-26)0.732
AKI (%)35 (21.9)35 (24.6)0.569
Liver function test during the first five days after LDLT
    Peak ALT (U/L)551 (386-972)619 (416-1151)0.108
    Peak AST (U/L)666 (472-1186)748 (495-1386)0.103
    Peak TB (µmol/L)80 (52-114)88 (65-126)0.034
One-year survival rate (%)157 (98.1)131 (92.3)0.015
ICU: Intensive care unit; AKI: Acute kidney injury; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TB: Total bilirubin.
Table 4 Univariate and multivariate analyses of risk factors for myocardial injury during pediatric living donor liver transplantation
Factor
Univariate analysis OR (95%CI)
P value
Multivariate analysis OR (95%CI)
P value
Preoperative recipient-related data
Age0.989 (0.974-1.003)0.125
Male gender1.081 (0.688-1.699)0.735
Height0.969 (0.951-0.988)0.0021.011 (0.964-1.060)0.659
Weight0.889 (0.827-0.955)0.0010.953 (0.800-1.136)0.593
LVEF1.044 (0.980-1.112)0.178
QTc0.999 (0.990-1.008)0.774
PELD1.074 (1.049-1.100)< 0.0011.065 (1.013-1.121)0.014
ALT1.001 (0.999-1.002)0.540
AST1.001 (1.000-1.002)0.218
Total Bilirubin1.004 (1.002-1.006)< 0.0011.001 (0.999-1.003)0.353
INR2.167 (1.435-3.272)< 0.0010.957 (0.554-1.653)0.875
Creatinine0.99 (0.951-1.031)0.632
Hemoglobin1.031 (0.897-1.184)0.670
Vital signs immediately before reperfusion
HR0.994 (0.977-1.012)0.513
MAP0.971 (0.949-0.993)0.0100.997 (0.971-1.023)0.819
CVP0.974 (0.896-1.057)0.524
Temperature1.088 (0.819-1.444)0.560
Laboratory findings before reperfusion
pH0.902 (0.032-25.155)0.952
PCO20.971 (0.935-1.009)0.129
PO20.999 (0.996-1.002)0.478
Lactate1.267 (1.092-1.469)0.0021.158 (0.990-1.355)0.067
Base excess0.946 (0.881-1.015)0.122
Ca0.374 (0.066-2.117)0.266
K0.857 (0.575-1.277)0.447
Hemoglobin0.836 (0.713-0.981)0.0290.956 (0.828-1.105)0.544
Duration of anhepatic phase1.019 (1.004-1.035)0.0161.021 (1.003-1.040)0.025
Donor-related data
Cold ischemic time1.006 (1.001-1.012)0.0161.003 (0.997-1.010)0.334
Graft weight0.999 (0.996-1.003)0.755
PRS2.260 (1.420-3.598)0.0011.966 (1.111-3.480)0.020
The data at the end of the surgery
Duration of surgery1 (0.998-1.002)0.854
Duration of anesthesia1.001 (0.999-1.003)0.481
Blood loss1.001 (1.000-1.002)0.128
RBCs transfusion1.151 (0.970-1.366)0.107
FFP transfusion1.002 (1.000-1.004)0.0171.001 (0.999-1.003)0.441
LVEF: Left ventricular ejection fraction; PELD: Pediatric end-stage liver disease; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; INR: International normalized ratio; MAP: Mean arterial pressure; CVP: Central venous pressure; PRS: Postreperfusion syndrome; RBCs: Red blood cells; FFP: Fresh frozen plasma.