Hepatic Ischemia/Reperfusion Injury After Liver Transplantation Is Not Associated with Early Impairment of Left Ventricular Ejection Fraction.
Hepatic Ischemia/Reperfusion Injury After Liver Transplantation Is Not Associated with Early Impairment of Left Ventricular Ejection Fraction.
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DOI：
10.12659/aot.938105
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发表时间：
2022-12-13
影响因子：
1.1
通讯作者：
Kubal, Chandrashekhar
中科院分区：
文献类型：
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作者：
Rokop, Zachary P.;Frick, Kyle;Zenisek, Joseph;Kroepfl, Elizabeth;Mihaylov, Plamen;Patidar, Kavish R.;Nephew, Lauren;Mangus, Richard S.;Kubal, Chandrashekhar
早期心肌功能障碍是肝移植后的一种已知并发症。尽管肝脏缺血/再灌注损伤（hIRI）已被证明会导致大鼠和猪模型中的心肌损伤，但hIRI与人类早期心肌功能障碍之间的临床联系尚未确定。我们试图通过成人肝移植受者术后第1天经胸超声心动图（TTE）的心脏评估来确定这种关系。于2020年1月至2021年4月期间移植的所有肝移植患者均于POD 1进行TTE。肝脏IRI通过POD 1时的血清AST水平分层（无：<200;轻度：200-2000;中度：2000-5000;重度：>5000）。所有患者均进行了移植前TTE，作为移植评估的一部分。在2020年至2021年期间，共有173名患者接受了肝移植（LT），并在POD 1（中位超声心动图时间：1天）进行了TTE。142例（82%）患者存在hIRI（69%轻度，8.6%中度，4%重度）。对整个研究人群的LT前和LT后左心室射血分数（LVEF）进行配对分析，结果显示LT后LVEF无显著降低（平均差异：-1.376%，P=0.08）。当患者按hIRI的严重程度分层时，LT后LVEF无显著差异。3例患者（1.7%）有明显的移植后LVEF受损（<35%）。这些患者均未出现明显的hIRI。肝移植后hIRI与LVEF立即降低无关。肝移植后心肌病的病理生理学可能由肝外触发因素驱动。
Early myocardial dysfunction is a known complication following liver transplant. Although hepatic ischemia/reperfusion injury (hIRI) has been shown to cause myocardial injury in rat and porcine models, the clinical association between hIRI and early myocardial dysfunction in humans has not yet been established. We sought to define this relationship through cardiac evaluation via transthoracic echocardiography (TTE) on postoperative day (POD) 1 in adult liver transplant recipients. TTE was performed on POD1 in all liver transplant patients transplanted between January 2020 and April 2021. Hepatic IRI was stratified by serum AST levels on POD1 (none: <200; mild: 200–2000; moderate: 2000–5000; severe: >5000). All patients had pre-transplant TTE as part of the transplant evaluation. A total of 173 patients underwent liver transplant (LT) between 2020 and 2021 and had a TTE on POD 1 (median time to echo: 1 day). hIRI was present in 142 (82%) patients (69% mild, 8.6% moderate, 4% severe). Paired analysis between pre-LT and post-LT left ventricular ejection fraction (LVEF) of the entire study population demonstrated no significant decrease following LT (mean difference: −1.376%, P=0.08). There were no significant differences in post-LT LVEF when patients were stratified by severity of hIRI. Three patients (1.7%) had significant post-transplant impairment of LVEF (<35%). None of these patients had significant hIRI. hIRI after liver transplantation is not associated with immediate reduction in LVEF. The pathophysiology of post-LT cardiomyopathy may be driven by extra-hepatic triggers.