Takotsubo Syndrome in Orthotopic Liver Transplant: A Systematic Review and Pooled Analysis of Published Studies and Case Reports.

IF 0.8 4区医学 Q4 IMMUNOLOGY Transplantation proceedings Pub Date : 2024-11-01 Epub Date: 2023-02-27 DOI:10.1016/j.transproceed.2022.11.005

Milana Bachayev, Brian Brereton, Avilash Mondal, Bibi Amena Alli-Ramsaroop, Roshan Dhakal, Maria C Buhl Leon, Camila M Quinones, Mohamed Eyad O Abdelal, Akhil Jain, Kartik Dhaduk, Rupak Desai

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Abstract

Background: Takotsubo syndrome (TTS) has been reported in solid-organ transplant recipients. However, the pooled data regarding TTS after liver transplant remain limited.

Methods: A systematic review was performed through February 2022 using PubMed, Embase, Scopus, and Google Scholar to review case reports/series and original studies on liver transplant-associated TTS. Descriptive analysis was performed for case reports and pooled analysis for the prevalence using random effects models.

Results: A total of 56 case reports were included from 30 articles (51.8 % male; mean age, 53 years; India 56%, US 27%, and Europe 8.93%) and 10 original studies (US 88.65%, India 10.92%) revealing liver transplant-associated TTS. The pooled prevalence of TTS was 1.1% (95% Cl, 0.6%-1.7%) of all liver transplants with comparable rates in studies from India and the US (P = .92). Indications for liver transplant included end-stage liver disease due to alcohol-related cirrhosis (25%), hepatitis C virus infection (17.9%), hepatocellular carcinoma (10.7%), and non-alcohol-related steatohepatitis (8.9%); the average Model for End-Stage Liver Disease score was 24.75. TTS commonly presented as hypotension (30%), dyspnea (14%), and oliguria, occurring mostly post-transplant (82%), whereas 14% were intraoperative. Common electrocardiogram findings were ST changes, ventricular tachycardia, and atrial fibrillation. Common echocardiogram findings showed left ventricular apical ballooning in 46.5% of cases and reduced ejection fraction < 20% in 41.9% of cases. Common complications were cardiogenic shock (32.1 %), acute kidney injury (12.5%), arrhythmia, stroke, cardiac arrest, and hepatic artery thrombosis. Mechanical circulatory support was required in 30.3%. Recurrence was reported in 15, and mortality in 30.4% of patients.

Conclusions: Takotsubo syndrome prevalence after liver transplant is significantly higher than TTS prevalence in general US hospitalizations with potentially worse outcomes. Prospective registries reporting TTS in liver transplant recipients are warranted.

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正位肝移植中的塔克次氏综合征：已发表研究和病例报告的系统回顾和汇总分析。

背景：据报道，在实体器官移植受者中出现过多囊综合征（TTS）。然而，有关肝移植后 TTS 的综合数据仍然有限：方法：使用PubMed、Embase、Scopus和Google Scholar对肝移植相关TTS的病例报告/系列研究和原始研究进行了系统性回顾。对病例报告进行了描述性分析，并使用随机效应模型对患病率进行了汇总分析：30篇文章（51.8%为男性；平均年龄53岁；印度占56%，美国占27%，欧洲占8.93%）和10项原创研究（美国占88.65%，印度占10.92%）共收录了56份病例报告，揭示了肝移植相关的TTS。在所有肝移植中，TTS的总发病率为1.1%（95% Cl，0.6%-1.7%），印度和美国研究中的发病率相当（P = .92）。肝移植的适应症包括酒精相关性肝硬化（25%）、丙型肝炎病毒感染（17.9%）、肝细胞癌（10.7%）和非酒精相关性脂肪性肝炎（8.9%）导致的终末期肝病；终末期肝病模型的平均评分为 24.75 分。TTS通常表现为低血压（30%）、呼吸困难（14%）和少尿，大部分发生在移植后（82%），14%发生在术中。常见的心电图检查结果为 ST 改变、室性心动过速和心房颤动。常见的超声心动图检查结果显示，46.5%的病例出现左室心尖气囊，41.9%的病例射血分数降低<20%。常见并发症为心源性休克（32.1%）、急性肾损伤（12.5%）、心律失常、中风、心脏骤停和肝动脉血栓。30.3%的患者需要机械循环支持。有 15 例患者复发，30.4% 的患者死亡：结论：肝移植术后的塔克次氏综合征发病率明显高于美国普通住院患者的TTS发病率，其结果可能更糟。有必要对肝移植受者的 TTS 进行前瞻性登记。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.

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