Incidence and Predictors of Postoperative Atrial Fibrillation in Kidney Transplant Recipients

Manna, Gaetano La; Boriani, Giuseppe; Capelli, Irene; Marchetti, Antonio; Grandinetti, Valeria; Spazzoli, Alessandra; Dalmastri, Vittorio; Todeschini, Paola; Rucci, Paola; Stefoni, Sergio

doi:10.1097/tp.0b013e3182a2b492

Cited by 22 publications

(30 citation statements)

References 26 publications

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“…However, POAF occurring several years later may have different etiologies and risk profiles compared with those occurring in the immediate postoperative period. One study with 26 patients found the incidence of POAF was 20% after combined kidney and liver transplant (16). In our study, 88 patients had combined kidney and liver transplant.…”

Section: Discussionmentioning

confidence: 92%

Postoperative Atrial Fibrillation in Liver Transplantation

Xia

Apinyachon

Huang

et al. 2015

American Journal of Transplantation

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Postoperative atrial fibrillation (POAF) is common after major surgeries and is associated with increased morbidity and mortality. POAF after liver transplantation (LT) has not been reported. This study was undertaken to investigate the incidence, impact, and risk factors of POAF in LT patients. After IRB approval, LT between January 2006 and August 2013 at our center were retrospectively reviewed. POAF that occurred within 30 days after LT was included. Patients with and without POAF were compared and independent risk factors were identified by logistic regression. Of 1387 adults LT patients, 102 (7.4%) developed POAF during the study period. POAF was associated with significantly increased mortality, graft failure, acute kidney injury and prolonged hospital stay. Independent risk factors included age, body weight, MELD score, presence of previous history of AF, the vasopressors use prior to LT and pulmonary artery diastolic pressure at the end of LT surgery (odds ratios 2.0-7.2, all p < 0.05). A risk index of POAF was developed and patients with the high-risk index had more than 60% chance of developing POAF. These findings may be used to stratify patients and to guide prophylaxis for POAF in the posttransplant period.

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Section: Discussionmentioning

confidence: 92%

Postoperative Atrial Fibrillation in Liver Transplantation

Xia

Apinyachon

Huang

et al. 2015

American Journal of Transplantation

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“…This hypothesis is amenable for intervention trials that would aim to establish and maintain sinus rhythm before and during the intraoperative transplantation phase. It has recently been reported that development of AF in the postoperative period after kidney transplantation can be predicted by recipient age, a history of myocardial infarction, and combined liver/kidney transplantation . The pathophysiological mechanisms that trigger postoperative AF remain unclear, but ischemia/reperfusion events, resulting in the formation of oxidative stress and a systemic inflammatory response, have been shown to cause structural modifications of myocardial tissue and atrial remodeling …”

Section: Discussionmentioning

confidence: 99%

“…It has recently been reported that development of AF in the postoperative period after kidney transplantation can be predicted by recipient age, a history of myocardial infarction, and combined liver/kidney transplantation. 19 The pathophysiological mechanisms that trigger postoperative AF remain unclear, but ischemia/reperfusion events, resulting in the formation of oxidative stress and a systemic inflammatory response, have been shown to cause structural modifications of myocardial tissue and atrial remodeling. [20][21][22] The American Heart Association and the American College of Cardiology currently recommend betamimetic blockers for the prevention of postoperative AF in patients undergoing cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Preexisting atrial fibrillation and cardiac complications after liver transplantation

Bargehr

Trejo-Gutiérrez

Patel³

et al. 2015

Liver Transpl

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Atrial fibrillation (AF) is the most common cardiac arrhythmia, and it is associated with increased cardiovascular morbidity and all-cause mortality. Our aim was to determine the impact of preexisting AF on patients undergoing liver transplantation (LT). A retrospective case-control study was performed. Records from patients who underwent LT between January 2005 and December 2008 at Mayo Clinic Florida were reviewed. Patients with preexisting AF were identified and matched to patients who did not have a diagnosis of AF. Thirty-two of 717 LT recipients (4.5%) had AF before LT. These patients were compared to a control group of 63 LT recipients. Pre-LT left ventricular hypertrophy (P 5 0.03), a history of congestive heart failure (P 5 0.04), and a history of stroke or transient ischemic attack (P 5 0.03) were significantly more prevalent in patients with AF versus controls. Intraoperative adverse cardiac events (P 5 0.02) and AF-related adverse postoperative events (P < 0.001) were more common in the recipients with known AF. Six patients with paroxysmal AF (19%) developed chronic/ persistent AF postoperatively. Graft survival and patient survival were similar in the groups. Although patients with AF had a higher incidence of intraoperative cardiac events, a higher cardiovascular morbidity rate, and a complicated postoperative course, this did not affect overall graft and patient survival. Liver Transpl 21:314-320, 2015. V C 2014 AASLD. Atrial fibrillation (AF) is the most common cardiac arrhythmia with an estimated incidence of 28.3 per 1000 person-years in the United States. 1 The prevalence of AF is 0.95% to 2.3% in the general population; however, it is more prevalent in men and older individuals. 2-4 AF affects approximately 2.3 million Americans, and it is projected that more than 5.6 million Americans will have this condition by 2050. 3 Liver transplantation (LT) outcomes have improved in the last 2 decades, but cardiovascular complications remain a leading cause of death in LT recipients. 5-7 These complications have been attributed to immunosuppressive regimens and preexisting cardiac disease. 8,9 For this reason, LT candidates undergo an extensive preoperative cardiac assessment to ensure adequate function. 10,11 It is known that AF is associated with an increased risk of stroke, heart failure, and all-cause mortality in the general population; however, the impact of AF on patients undergoing LT is largely unknown. 12,13 Our aim in this study was to determine the morbidity and mortality associated with AF in patients undergoing LT. PATIENTS AND METHODSA retrospective analysis was performed of all patients who underwent LT between January 2005 and December 2008 at our institution. This study was reviewed

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“…47 Among 304 kidney transplant recipients at a single center in Italy, 6.9% had incident AF in the post-operative period after surgery (median time of 3 days). 48 The cumulative post-operative AF risk was highest on the day of surgery (2.5%), increased steeply up to day 3 (5.3%) and reached 9.5% on the 19 th day of admission. 48 The highest risk of incident AF after kidney transplant was among kidney transplant recipients who were older, men and white with a higher burden of hypertension and coronary heart disease.…”

Section: Af and Kidney Transplantmentioning

confidence: 87%

“…48 The cumulative post-operative AF risk was highest on the day of surgery (2.5%), increased steeply up to day 3 (5.3%) and reached 9.5% on the 19 th day of admission. 48 The highest risk of incident AF after kidney transplant was among kidney transplant recipients who were older, men and white with a higher burden of hypertension and coronary heart disease. Another analysis examined the prevalence of pre - transplant AF and associated outcomes after transplant among over 62,000 first kidney transplant recipients.…”

Section: Af and Kidney Transplantmentioning

confidence: 87%

Intersection of cardiovascular disease and kidney disease

Bansal

Hsu

2014

Current Opinion in Nephrology and Hypertension

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Purpose of review Atrial fibrillation (AF) is the most common sustained arrhythmia in the patients with kidney disease. The purpose of this review is to describe the burden of AF in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD), postulate possible mechanisms to explain this burden of disease, understand the clinical consequences of AF and review the treatment options for AF specific to patients with kidney disease. Recent findings Recent literature has revealed that the clinical multi-organ impact of AF in patients with CKD and ESRD is substantial. Although novel oral anticoagulants to treat AF and prevent associated complications have been tested in large trials in the general population, there is a paucity of data on the efficacy and safety of these agents in patients with advanced CKD and ESRD. Summary AF is a significant comorbidity in patients with CKD and ESRD with important prognostic implications. More research is needed to understand the mechanisms that contribute to the disproportionate burden of this arrhythmia in patients with kidney disease and treatment options specific to this population of high-risk patients.

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Incidence and Predictors of Postoperative Atrial Fibrillation in Kidney Transplant Recipients

Cited by 22 publications

References 26 publications

Postoperative Atrial Fibrillation in Liver Transplantation

Postoperative Atrial Fibrillation in Liver Transplantation

Preexisting atrial fibrillation and cardiac complications after liver transplantation

Intersection of cardiovascular disease and kidney disease

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