Risk factors for myocardial injury during living donor liver transplantation in pediatric patients with biliary atresia

Table 1 Preoperative recipient-related data

Variable	Non-myocardial injury (n = 160)	Myocardial injury (n = 142)	P value
Age (mo)	9.5 (6.0-16.8)	7.0 (6.0-11.0)	< 0.001
Male gender (%)	78 (48.8)	72 (50.7)	0.735
Height (cm)	70 (65-82)	65 (62-70)	< 0.001
Weight (kg)	8.0 (6.5-11.0)	7.0 (6.0-8.0)	< 0.001
LVEF (%)	64 (62-67)	65 (62-67)	0.167
QTc(ms)	404 (387-427)	405 (384-424)	0.596
PELD score	14 (4-21)	22 (15-28)	< 0.001
ALT (U/L)	106 (61-168)	103 (70-172)	0.494
AST (U/L)	177 (103-319)	196 (129-295)	0.186
TB (µmol/L)	166 (40-278)	262 (157-349)	< 0.001
INR	1.29 (1.09-1.63)	1.52 (1.23-2.04)	< 0.001
Cr (µmol/L)	14.0 (12.0-16.0)	13.5 (10.0-16.0)	0.528
Hemoglobin (g/L)	93 ± 17	93 ± 16	0.671

LVEF: Left ventricular ejection fraction; PELD: Pediatric end-stage liver disease; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TB: Total bilirubin; INR: International normalized ratio; Cr: Creatinine.

Table 2 Intraoperative recipient-related data and donor-related data

Variable	Non-myocardial injury (n = 160)	Myocardial injury (n = 142)	P value
Vital signs immediately before reperfusion
HR (bpm/min)	118 ± 13	117±13	0.515
MAP (mmHg)	60 (54-67)	56 (51-62)	0.001
CVP (mmHg)	5 (4-7)	5 (3-7)	0.454
Temperature (°C)	36.5 (35.9-37.0)	36.5 (35.8-37.0)	0.652
Laboratory findings before reperfusion
pH	7.39 ± 0.07	7.39 ± 0.07	0.952
PCO2 (mmHg)	34 (30-39)	33 (30-38)	0.148
PO2 (mmHg)	257 (176-309)	242 (170-312)	0.472
Lactate (mmol/L)	2.5 (1.8-3.2)	2.7 (2.2-3.8)	0.002
Base excess (mmol/L)	-4.2 (-6.5--1.7)	-4.8 (-6.8--3.1)	0.102
Ca (mmol/L)	1.08 (1.01-1.17)	1.09 (1.00-1.15)	0.648
K (mmol/L)	3.8±0.6	3.8±0.5	0.448
Hemoglobin (g/L)	84 (75-93)	81 (72-91)	0.038
Duration of anhepatic phase (min)	56 (47-67)	62 (50-76)	0.019
Donor-related data
Cold ischemic time (min)	80 (64-106)	90 (71-111)	0.023
Graft weight (g)	244 (217-277)	243 (208-278)	0.654
PRS (%)	54 (33.8)	76 (53.5)	0.001
The data at the end of the surgery
Duration of surgery (min)	542 (495-600)	540 (484-593)	0.814
Duration of anesthesia (min)	616 (555-651)	610 (559-650)	0.984
Blood loss (mL)	300 (200-400)	350 (200-400)	0.378
Urine output (mL)	400 (300-600)	400 (248-600)	0.909
RBCs transfusion (units)	2.0 (1.5-3.0)	2.0 (2.0-3.0)	0.078
FFP transfusion (mL)	0 (0-100)	0 (0-200)	0.009

HR: Heart rate; MAP: Mean arterial pressure; CVP: Central venous pressure; PRS: Postreperfusion syndrome; RBCs: Red blood cells; FFP: Fresh frozen plasma.

Table 3 Postoperative recipient-related data

Variable	Non-myocardial injury (n = 160)	Myocardial injury (n =142)	P value
Ventilation time (min)	220 (129-351)	196 (146-321)	0.785
ICU stay (d)	2 (2.0-3.0)	3 (2.0-3.5)	0.041
hospital stay (d)	20 (16-29)	21 (17-26)	0.732
AKI (%)	35 (21.9)	35 (24.6)	0.569
Liver function test during the first five days after LDLT
Peak ALT (U/L)	551 (386-972)	619 (416-1151)	0.108
Peak AST (U/L)	666 (472-1186)	748 (495-1386)	0.103
Peak TB (µmol/L)	80 (52-114)	88 (65-126)	0.034
One-year survival rate (%)	157 (98.1)	131 (92.3)	0.015

ICU: Intensive care unit; AKI: Acute kidney injury; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TB: Total bilirubin.

Table 4 Univariate and multivariate analyses of risk factors for myocardial injury during pediatric living donor liver transplantation

Factor	Univariate analysis OR (95%CI)	P value	Multivariate analysis OR (95%CI)	P value
Preoperative recipient-related data
Age	0.989 (0.974-1.003)	0.125
Male gender	1.081 (0.688-1.699)	0.735
Height	0.969 (0.951-0.988)	0.002	1.011 (0.964-1.060)	0.659
Weight	0.889 (0.827-0.955)	0.001	0.953 (0.800-1.136)	0.593
LVEF	1.044 (0.980-1.112)	0.178
QTc	0.999 (0.990-1.008)	0.774
PELD	1.074 (1.049-1.100)	< 0.001	1.065 (1.013-1.121)	0.014
ALT	1.001 (0.999-1.002)	0.540
AST	1.001 (1.000-1.002)	0.218
Total Bilirubin	1.004 (1.002-1.006)	< 0.001	1.001 (0.999-1.003)	0.353
INR	2.167 (1.435-3.272)	< 0.001	0.957 (0.554-1.653)	0.875
Creatinine	0.99 (0.951-1.031)	0.632
Hemoglobin	1.031 (0.897-1.184)	0.670
Vital signs immediately before reperfusion
HR	0.994 (0.977-1.012)	0.513
MAP	0.971 (0.949-0.993)	0.010	0.997 (0.971-1.023)	0.819
CVP	0.974 (0.896-1.057)	0.524
Temperature	1.088 (0.819-1.444)	0.560
Laboratory findings before reperfusion
pH	0.902 (0.032-25.155)	0.952
PCO2	0.971 (0.935-1.009)	0.129
PO2	0.999 (0.996-1.002)	0.478
Lactate	1.267 (1.092-1.469)	0.002	1.158 (0.990-1.355)	0.067
Base excess	0.946 (0.881-1.015)	0.122
Ca	0.374 (0.066-2.117)	0.266
K	0.857 (0.575-1.277)	0.447
Hemoglobin	0.836 (0.713-0.981)	0.029	0.956 (0.828-1.105)	0.544
Duration of anhepatic phase	1.019 (1.004-1.035)	0.016	1.021 (1.003-1.040)	0.025
Donor-related data
Cold ischemic time	1.006 (1.001-1.012)	0.016	1.003 (0.997-1.010)	0.334
Graft weight	0.999 (0.996-1.003)	0.755
PRS	2.260 (1.420-3.598)	0.001	1.966 (1.111-3.480)	0.020
The data at the end of the surgery
Duration of surgery	1 (0.998-1.002)	0.854
Duration of anesthesia	1.001 (0.999-1.003)	0.481
Blood loss	1.001 (1.000-1.002)	0.128
RBCs transfusion	1.151 (0.970-1.366)	0.107
FFP transfusion	1.002 (1.000-1.004)	0.017	1.001 (0.999-1.003)	0.441

LVEF: Left ventricular ejection fraction; PELD: Pediatric end-stage liver disease; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; INR: International normalized ratio; MAP: Mean arterial pressure; CVP: Central venous pressure; PRS: Postreperfusion syndrome; RBCs: Red blood cells; FFP: Fresh frozen plasma.