Meta-Analysis
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2018; 10(10): 761-771
Published online Oct 27, 2018. doi: 10.4254/wjh.v10.i10.761
Liver transplantation and atrial fibrillation: A meta-analysis
Ronpichai Chokesuwattanaskul, Charat Thongprayoon, Tarun Bathini, Patompong Ungprasert, Konika Sharma, Karn Wijarnpreecha, Pavida Pachariyanon, Wisit Cheungpasitporn
Ronpichai Chokesuwattanaskul, Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
Charat Thongprayoon, Tarun Bathini, Konika Sharma, Karn Wijarnpreecha, Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, United States
Patompong Ungprasert, Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Pavida Pachariyanon, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, United States
Wisit Cheungpasitporn, Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, United States
Author contributions: Chokesuwattanaskul R and Thongprayoon C contributed to acquisition of data, analysis and interpretation of data, drafting the articles, final approval; Bathini T and Sharma K contributed to acquisition of data, drafting the articles, final approval; Wijarnpreecha K and Ungprasert P contributed to interpretation the data, revising the article, final approval; Pachariyanon P contributed to interpretation the data, revising the article, final approval; Cheungpasitporn W contributed to conception and design of the study, critical revision, final approval.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wisit Cheungpasitporn, MD, Assistant Professor, Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS 39216, United States. wcheungpasitporn@gmail.com
Telephone: +1-601-9845670 Fax: +1-601-9845765
Received: May 2, 2018
Peer-review started: May 3, 2018
First decision: May 17, 2018
Revised: June 24, 2018
Accepted: June 28, 2018
Article in press: June 29, 2018
Published online: October 27, 2018
Processing time: 179 Days and 17.6 Hours
ARTICLE HIGHLIGHTS
Research background

Among liver transplant patients with atrial fibrillation (AF), there are lacks of data about incidence, prevalence and prognosis of AF in this specific group of patients. In spite of improvement of liver transplant care to the point of achieving almost 90% of 1-year survival rate, outcomes of liver transplantation related to AF remain unclear.

Research motivation

With excellent results of liver transplantation in term of survival, current indications of the transplantation have been extending into higher risk candidates due to higher amount of donors and more advanced treatment, which include preoperative preparation, surgical technique, immunosuppressive therapy and post-transplantation care. The high-risk liver transplant candidates tend to experience the adverse effects throughout perioperative period and worse outcomes, compared to those with less comorbidity. AF is one of the most common cardiac rhythm abnormalities and its prevalence increases with older age and higher comorbidities. Therefore, a number of patients with AF who received liver transplantation would definitely increase.

Research objectives

To examine outcomes of liver transplant recipients with AF, we performed this meta-analysis: (1) to assess prevalence of pre-existing AF and/or incidence of AF following liver transplantation, and the trends of patient's outcomes overtime; and (2) to evaluate impact of pre-existing AF and post-operative AF on patient outcomes following liver transplantation. Innovations and breakthroughs.

Research methods

We conducted a systematic literature search of EMBASE, Ovid MEDLINE, and the Cochrane Database (from database inception to March 2018): (1) to estimate prevalence of pre-existing AF and/or incidence of AF following liver transplantation; and (2) to evaluate impact of pre-existing AF and post-operative AF on patient outcomes following liver transplantation. Estimated prevalence, incidence and estimated risks from each study were incorporated by the random-effect, generic inverse-variance approach of DerSimonian and Laird.

Research results

There were significant associations of AF with worse clinical outcomes following liver transplantation including 2.3-fold higher risk of death and 5.1-fold higher risk of postoperative cardiovascular complications, and poor clinical outcomes such as stroke, acute kidney injury and graft failure. We also showed the incidence of postoperative AF, namely 8.5%, consistently across different type of studies without the change overtime by meta-regression.

Research conclusions

The overall estimated prevalence of pre-existing AF and incidence of AF following liver transplantation are 5.4% and 8.5%, respectively. Incidence of AF following liver transplant does not seem to decrease overtime. Pre-existing AF and new-onset AF are potentially associated with poor clinical outcomes post liver transplantation.

Research perspectives

This systematic review confirmed higher risks of death and postoperative complications in liver transplant patients with AF. Our findings indicate that AF may be an independent predictor for worse clinical outcomes following liver transplantation.