The Association of Pre-Transplant Atrial Fibrillation with In-Hospital
Outcomes in Patients Undergoing Orthotopic Liver Transplantation: A
Propensity Score Matching Analysis
Abstract
In this study, we sought to evaluate the prevalence and association of
pre-transplant atrial fibrillation (AF) on 30-day postoperative outcomes
in patients undergoing orthotopic liver transplant (OLT). The National
Inpatient Sample Database was queried from 2011 to 2017 for relevant
ICD-9 and ICD-10 procedural and diagnostic codes. Baseline
characteristics and in-hospital outcomes were compared in patients who
underwent OLT with AF and those without. Among 45,357 patients who
underwent OLT, women made up 35.8 % of the overall population. The
prevalence of AF prior to transplant was 2932 (6.5%) with a trend
towards increasing prevalence, with an annual change rate of 4.19%.
Applying propensity score matching to control for potential confounding
factors, there was no association between pre-transplant AF and
in-hospital mortality in patients undergoing OLT, however, there was a
higher incidence of perioperative complications. Older age, the presence
of heart failure, and anemia were independently predictive of higher
mortality in patients with pre-transplant AF undergoing OLT. In patients
undergoing OLT, pre-transplant AF is increasing in prevalence and
appears to be associated with similar in-hospital mortality but worse
perioperative outcomes. Greater emphasis should be placed on AF in the
preoperative cardiovascular risk stratification of patients undergoing
OLT.