Retrospective Study
Copyright ©The Author(s) 2025.
World J Gastrointest Surg. Apr 27, 2025; 17(4): 103263
Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.103263
Table 1 Demographic characteristics and outcomes, n (%)
Total (n = 321)
Non-myocardial injury (n = 171)
Myocardial injury (n = 150)
P value
Preoperative clinical data
Age (month)8.0 (6.0, 12.0)9.0 (6.0, 16.5)7.0 (6.0, 12.0)0.002
Male gender155 (48.3)85 (49.7)70 (46.7)0.666
Weight (kg)7.4 (6.5, 10.0)7.9 (6.5, 11.0)7.0 (6.5, 8.3)0.003
Height (cm)67 (63, 78)70 (64, 82)66 (63, 71)0.002
QTc (ms)405 (387, 423)404 (387, 423)406 (387, 430)0.483
LVEF (%)64 (62, 67)64 (62, 66)65 (62, 67)0.254
NLR0.78 (0.50, 1.29)0.56 (0.42, 0.96)1.10 (0.74, 1.88)< 0.001
PLR39.5 (28.2, 55.2)38.4 (27.4, 51.0)40.7 (28.9, 57.6)0.067
hsCRP (mg/L)5.31 (2.26, 12.78)3.36 (0.92, 7.19)9.66 (5.09, 26.43)< 0.001
Albumin (g/L)34.3 (32.0, 38.3)35.0 (32.9, 39.5)33.6 (31.0, 36.5)0.001
TB (μmol/L)225 (77, 317)172 (39, 278)258 (153, 352)< 0.001
AST (U/L)190 (119, 303)191(113, 330)186 (124, 290)0.656
ALT (U/L)113 (71, 174)119 (65, 197)110 (74, 153)0.565
Creatinine (μmol/L)13.0 (11.0, 16.0)14.0 (12.0, 16.0)12.0 (10.0, 15.0)0.017
Hemoglobin (g/L), mean ± SD93 ± 1695 ± 1790 ± 150.011
Platelet (109/L)190 (127, 255)190 (126, 235)190 (130, 262)0.378
INR1.38 (1.13, 1.82)1.25 (1.06, 1.66)1.54 (1.32, 1.92)< 0.001
PELD< 0.001
    < 14.5103 (32.1)82 (48.0)21 (14.0)
    ≥ 14.5218 (67.9)89 (52.0)129 (86.0)
Graft-related data
Graft Weight (g)244 (214, 280)246 (214, 277)244 (217, 280)0.814
Graft CIT (minute)86 (66, 112)85 (66, 109)86 (67, 115)0.275
Intraoperative clinical data
Laboratory test results before reperfusion
    pH, mean ± SD7.388 ± 0.0677.391 ± 0.0687.384 ± 0.0670.379
    Base excess (mmol/L)-4.40 (-6.40, -2.40)-4.40 (-6.25, -1.90)-4.40 (-6.65, -3.00)0.338
    Lactate (mmol/L)2.60 (2.10, 3.40)2.50 (1.90, 3.10)2.70 (2.20, 3.70)0.001
    Hemoglobin (g/L)82 (73, 92)84 (75, 93)81 (73, 91)0.219
    K (mmol/L)3.70 (3.40, 4.10)3.70 (3.50, 4.20)3.70 (3.40, 4.07)0.405
    Ca (mmol/L)1.09 (1.01, 1.16)1.09 (1.01, 1.16)1.08 (1.01, 1.16)0.827
Vital signs before reperfusion
    Heart rate (beats/minute), mean ± SD117 ± 13119 ± 14115 ± 120.029
    MAP (mmHg)58 (52, 66)59 (54, 67)56 (51, 64)0.014
    CVP (mmHg)5 (3, 7)5 (4, 7)5 (3, 7)0.821
    Temperature (°C)36.5 (35.9, 37.0)36.5 (35.9, 37.0)36.5 (35.8, 37.0)0.528
Anhepatic phase time (minute)48 (41, 58)48 (40, 56)49 (41, 62)0.141
PRS< 0.001
    No182 (56.7)124 (72.5)58 (38.7)
    Yes139 (43.3)47 (27.5)92 (61.3)
Data at the end of surgery
    Blood loss (mL)300 (200, 400)300 (200, 400)300 (200, 400)0.415
    RBCs transfusion (units)2.0 (2.0, 3.0)2.0 (1.5, 3.0)2.0 (2.0, 3.0)0.069
    FFP infusion (mL)0 (0, 150)0 (0, 100)0 (0, 200)0.005
    Fluid infusion (mL)1387 (1100, 1700)1387 (1100, 1770)1384 (1103, 1671)0.784
    Urine volume (mL)400 (280, 600)400 (300, 600)400 (240, 600)0.120
    Surgical time (minute)540 (490, 600)540 (495, 600)542 (481, 590)0.730
    Anaesthesia time (minute)615 (560, 650)615 (565, 650)616 (555, 655)0.650
Postoperative clinical data
Ventilation time (minute)205 (136, 340)230 (147, 349)185 (133, 320)0.193
ICU stay (day)2.5 (2.0, 3.0)2.0 (2.0, 3.0)3.0 (2.0, 3.4)0.044
AKI0.545
    No240 (74.8)125 (73.1)115 (76.7)
    Yes81 (25.2)46 (26.9)35 (23.3)
Liver function tests during the initial week following LDLT
    Peak TB (μmol/L)84 (56, 117)78 (50, 115)92 (66, 123)0.004
    Peak AST (U/L)697 (485, 1290)666 (448, 1180)758 (506, 1395)0.027
    Peak ALT (U/L)586 (404, 1089)585 (372, 1076)592 (415, 1138)0.247
Hospital stay (day)21 (17, 27)21 (17, 30)21 (17, 25)0.158
1-year survival rate306 (95.3)168 (98.2)138 (92.0)0.017
LVEF: Left ventricular ejection fraction; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; hsCRP: High sensitivity C-reactive protein; TB: Total bilirubin; AST: Aspartate transaminase; ALT: Alanine transaminase; INR: International normalized ratio; PELD: Pediatric end-stage liver disease; CIT: Cold ischemia time; MAP: Mean arterial pressure; CVP: Central venous pressure; PRS: Postreperfusion syndrome; RBC: Red blood cell; FFP: Fresh frozen plasma; ICU: Intensive care unit; AKI: Acute kidney injury; LDLT: Living donor liver transplantation.
Table 2 Clinical data of patients in the training and validation sets, n (%)
Training set (n = 225)
Validation set (n = 96)
P value
Preoperative clinical data
Age (month)8.0 (6.0, 12.0)9.0 (6.0, 16.3)0.434
Male gender108 (48.0)47 (49.0)0.972
Weight (kg)7.3 (6.5, 9.5)7.5 (6.5, 10.0)0.742
Height (cm)67 (64, 76)67 (63, 79)0.621
QTc (ms)405 (387, 423)407 (387, 422)0.862
LVEF (%)64 (62, 67)65 (62, 67)0.693
NLR0.79 (0.51, 1.28)0.78 (0.49, 1.43)0.878
PLR39.5 (27.5, 55.0)42.5 (30.3, 55.2)0.111
hsCRP (mg/L)5.31 (2.53, 13.93)5.04 (1.95, 10.63)0.262
Albumin (g/L)34.5 (32.0, 38.3)34.3 (31.7, 38.3)0.338
TB (μmol/L)226 (78, 317)223 (65, 314)0.372
AST (U/L)190 (123, 306)191 (108, 294)0.488
ALT (U/L)115 (68, 179)107 (72, 154)0.680
Creatinine (μmol/L)13.0 (11.0, 16.0)13.0 (11.0, 15.0)0.933
Hemoglobin (g/L), mean ± SD93 ± 1693 ± 170.916
Platelet (109/L)190 (128, 250)184 (118, 265)0.451
INR1.40 (1.13, 1.82)1.38 (1.13, 1.83)0.953
PELD score0.937
    < 14.573 (32.4)30 (31.3)
    ≥ 14.5152 (67.6)66 (68.8)
Graft-related data
Graft weight (g)244 (218, 277)246 (212, 281)0.849
Graft CIT (minute)85 (66, 112)88 (68, 119)0.556
Intraoperative clinical data
Laboratory test results before reperfusion
    pH, mean ± SD7.39 ± 0.077.38 ± 0.070.223
    Base excess (mmol/L)-4.40 (-6.20, -2.20)-4.40 (-6.82, -2.85)0.630
    Lactate (mmol/L)2.60 (2.00, 3.40)2.70 (2.20, 3.40)0.503
    Hemoglobin (g/L)84 (74, 92)81 (73, 92)0.572
    K (mmol/L)3.80 (3.50, 4.10)3.65 (3.40, 4.03)0.139
    Ca (mmol/L)1.09 (1.01, 1.17)1.08 (1.01, 1.14)0.306
Vital signs before reperfusion
    Heart rate (beats/minute), mean ± SD116 ± 13118 ± 120.202
    MAP (mmHg)59 (52, 66)58 (53, 64)0.736
    CVP (mmHg)5 (3, 7)5 (3, 7)0.539
    Temperature (°C)36.5 (35.9, 37.0)36.5 (36.0, 37.1)0.570
Anhepatic phase duration (minute)49 (41, 59)46 (40, 55)0.063
PRS0.611
    No125 (55.6)57 (59.4)
    Yes100 (44.4)39 (40.6)
Data at the end of surgery
    Blood loss (mL)300 (230, 400)300 (200, 400)0.079
    RBCs transfusion (units)2.0 (2.0, 3.0)2.0 (2.0, 2.5)0.117
    FFP infusion (mL)0 (0, 150)0 (0, 135)0.650
    Fluid infusion (mL)1400 (1109, 1745)1334 (1100, 1652)0.403
    Urine volume (mL)400 (260, 600)425 (300, 600)0.628
    Surgical time (minute)540 (480, 596)550 (504, 601)0.070
    Anaesthesia time (minute)615 (555, 649)625 (579, 663)0.066
Myocardial injury105 (46.7)45 (46.9)0.973
Postoperative clinical data
Ventilation time (minute)205 (135, 320)208 (139, 350)0.729
ICU stay (day)2.0 (2.0, 3.0)3.0 (2.0, 3.1)0.101
AKI0.839
    No167 (74.2)73 (76.0)
    Yes58 (25.8)23 (24.0)
Liver function tests during the initial week following LDLT
    Peak TB (μmol/L)83 (56, 121)86 (56, 111)0.700
    Peak AST (U/L)699 (483, 1333)691 (497, 1220)0.762
    Peak ALT (U/L)588 (408, 1084)579 (385, 1096)0.603
Hospital stay (day)21 (17, 26)21 (16, 29)0.609
One-year survival rate215 (95.6)91 (94.8)0.776
LVEF: Left ventricular ejection fraction; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; hsCRP: High sensitivity C-reactive protein; TB: Total bilirubin; AST: Aspartate transaminase; ALT: Alanine transaminase; INR: International normalized ratio; PELD: Pediatric end-stage liver disease; CIT: Cold ischemia time; MAP: Mean arterial pressure; CVP: Central venous pressure; PRS: Postreperfusion syndrome; RBC: Red blood cell; FFP: Fresh frozen plasma; ICU: Intensive care unit; AKI: Acute kidney injury; LDLT: Living donor liver transplantation.
Table 3 Multivariable logistic regression analysis of risk factors for myocardial injury
Risk factors
OR
95%CI
P value
PELD ≥ 14.54.4412.066-10.120< 0.001
hsCRP1.0851.045-1.133< 0.001
NLR3.3801.766-7.2820.001
PRS4.6622.330-9.676< 0.001
OR: Odds ratio; CI: Confidence interval; PELD: Pediatric end-stage liver disease; hsCRP: High sensitivity C-reactive protein; NLR: Neutrophil-to-lymphocyte ratio; PRS: Postreperfusion syndrome.