Intraoperative Cardiac Arrests in Asian Recipients of Liver Transplantation—Second Report After Learning Curve

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-12-21 DOI:10.1111/ctr.70038

Jisun Choi, SangHyun Lee, Justin Sangwook Ko, Mi Sook Gwak, Gaab Soo Kim

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Abstract

Background

Although surgical competency and anesthesia for liver transplantation (LT) have evolved significantly in the past decades, intraoperative cardiac arrest (ICA) is still an event that brings a poor prognosis to the recipient. We report a second-decade experience of ICA as a follow-up study of our first report at our institution.

Methods

This is a retrospective observational study of the medical records and the Liver Transplant Program database of our institution. LT from January 2011 to June 2023 were included. Of the 1735 LT cases, a total of 1730 cases were included, excluding three non-Asian and two simultaneous heart and liver transplants (1598 adult LT, 132 pediatric LT).

Results

The ICA incidence during adult LT was 0.7% (11/1598) which is significantly lower compared to our first report (1.5%; 14/919) (p = 0.042). ICA occurred only in adult recipients. Post-reperfusion syndrome (PRS, six cases) and bleeding (four cases) were the primary causes in most cases and most ICA occurred after reperfusion (10/11). The mortality rates within 24 h, 30 days, and 1 year were 27.3%, 45.5%, and 54.5%, respectively. The survival curve did not show a significant difference from our first report (p = 0.570), and the survival rate of the ICA group was significantly lower compared to the non-ICA group. (p = 0.000)

Conclusion

The incidence of ICA has decreased, but the main causes of ICA as PRS and bleeding after reperfusion have not changed. Additionally, there was no significant difference in the survival curves from the first report. Because ICA is still fatal, efforts to reduce its incidence should be continued.

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亚洲肝移植受者术中心脏骤停-学习曲线后的第二份报告

尽管在过去的几十年里，肝移植（LT）的手术能力和麻醉有了显著的发展，但术中心脏骤停（ICA）仍然是一个给接受者带来不良预后的事件。我们报告了ICA的第二个十年的经验，作为我们在我们机构的第一份报告的后续研究。方法对我院的病历和肝移植项目数据库进行回顾性观察研究。包括2011年1月至2023年6月的LT。在1735例LT病例中，共纳入1730例，不包括3例非亚洲人和2例同时进行的心脏和肝脏移植（1598例成人LT， 132例儿科LT）。结果成人LT的ICA发生率为0.7%(11/1598)，与我们的第一篇报道(1.5%；14/919) （p = 0.042）。ICA仅发生在成年受者中。再灌注后综合征（PRS， 6例）和出血（4例）是大多数病例的主要原因，ICA主要发生在再灌注后（10/11）。24 h、30 d和1年内的死亡率分别为27.3%、45.5%和54.5%。生存曲线与我们的第一篇报道没有明显差异（p = 0.570）， ICA组的生存率明显低于非ICA组。（p = 0.000）结论ICA的发生率虽有所下降，但发生ICA的主要原因仍为PRS和再灌注后出血。此外，与第一次报告相比，生存曲线没有显著差异。由于ICA仍然是致命的，应继续努力减少其发病率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.