Published online Oct 27, 2018. doi: 10.4254/wjh.v10.i10.761
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
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.
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.
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.
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.
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.
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.
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.