PMID- 31944566
OWN - NLM
STAT- MEDLINE
DCOM- 20210318
LR  - 20210318
IS  - 1527-6473 (Electronic)
IS  - 1527-6465 (Linking)
VI  - 26
IP  - 5
DP  - 2020 May
TI  - Intraoperative Troponin Elevation in Liver Transplantation Is Independently 
      Associated With Mortality: A Prospective Observational Study.
PG  - 681-692
LID - 10.1002/lt.25716 [doi]
AB  - Intraoperative factors implicated in postoperative mortality after liver 
      transplantation (LT) are poorly understood. Because LT is a particularly 
      demanding procedure, we hypothesized that intraoperative myocardial injury may be 
      frequent and independently associated with early postoperative outcomes. We aimed 
      to determine the association between intraoperative high-sensitivity troponin 
      (hsTn) elevation during LT and 30-day postoperative mortality. A total of 203 
      adult patients undergoing LT were prospectively included in the cohort and 
      followed during 1 year. Advanced hemodynamic parameters and serial 
      high-sensitivity troponin T (hsTnT) measurements were assessed at 6 
      intraoperative time points. The optimal hsTnT cutoff level for intraoperative 
      troponin elevation (ITE) was identified. Patients were classified into 2 groups 
      according to the presence of ITE. Independent impact of ITE on survival was 
      assessed through survival curves and multivariate Cox regression analysis. 
      Intraoperative cardiac function was compared between groups. Troponin levels 
      increased early during surgery in the ITE group. Troponin values at abdominal 
      closure were associated with 30-day mortality (area under the receiver operating 
      caracteristic curve, [AUROC], 0.73; P = 0.005). Patients with ITE showing values 
      of hsTnT >/=61 ng/L at abdominal closure presented higher 30-day mortality (29.6% 
      versus 3.4%; P < 0.001). ITE was independently associated with 30-day mortality 
      (hazard ratio, 3.8; 95% confidence interval, 1.1-13.8; P = 0.04) and with worse 
      overall intraoperative cardiac function. The hsTnT upper reference limit showed 
      no discriminant capacity during LT. Intraoperative myocardial injury identified 
      by hsTn elevation is frequently observed during LT, and it is associated with 
      myocardial dysfunction and short-term mortality. Determinations of hsTn may serve 
      as a valuable intraoperative monitoring tool during LT.
CI  - Copyright (c) 2020 by the American Association for the Study of Liver Diseases.
FAU - Vilchez-Monge, Almudena L
AU  - Vilchez-Monge AL
AUID- ORCID: 0000-0003-4520-9329
AD  - Department of Anesthesiology and Intensive Care, Hospital General Universitario 
      Gregorio Maranon, Madrid, Spain.
AD  - Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
FAU - Garutti, Ignacio
AU  - Garutti I
AD  - Department of Anesthesiology and Intensive Care, Hospital General Universitario 
      Gregorio Maranon, Madrid, Spain.
AD  - Instituto de Investigacion Sanitaria of Hospital General Universitario Gregorio 
      Maranon (IiSGM), Madrid, Spain.
AD  - Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
FAU - Jimeno, Concepcion
AU  - Jimeno C
AD  - Department of Anesthesiology and Intensive Care, Hospital General Universitario 
      Gregorio Maranon, Madrid, Spain.
FAU - Zaballos, Matilde
AU  - Zaballos M
AD  - Department of Anesthesiology and Intensive Care, Hospital General Universitario 
      Gregorio Maranon, Madrid, Spain.
AD  - Instituto de Investigacion Sanitaria of Hospital General Universitario Gregorio 
      Maranon (IiSGM), Madrid, Spain.
AD  - Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
FAU - Jimenez, Consuelo
AU  - Jimenez C
AD  - Department of Anesthesiology and Intensive Care, Hospital General Universitario 
      Gregorio Maranon, Madrid, Spain.
FAU - Olmedilla, Luis
AU  - Olmedilla L
AD  - Department of Anesthesiology and Intensive Care, Hospital General Universitario 
      Gregorio Maranon, Madrid, Spain.
FAU - Pineiro, Patricia
AU  - Pineiro P
AD  - Postoperative Care Unit, Hospital General Universitario Gregorio Maranon, Madrid, 
      Spain.
AD  - Department of Anesthesiology and Intensive Care, Hospital General Universitario 
      Gregorio Maranon, Madrid, Spain.
FAU - Duque, Patricia
AU  - Duque P
AD  - Postoperative Care Unit, Hospital General Universitario Gregorio Maranon, Madrid, 
      Spain.
AD  - Department of Anesthesiology and Intensive Care, Hospital General Universitario 
      Gregorio Maranon, Madrid, Spain.
FAU - Salcedo, Magdalena
AU  - Salcedo M
AD  - Hepatology and Liver Transplant Unit, Department of Digestive Diseases, Hospital 
      General Universitario Gregorio Maranon, Madrid, Spain.
AD  - Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas 
      (CIBEREHD), Madrid, Spain.
FAU - Asencio, Jose M
AU  - Asencio JM
AD  - Department of Surgery, Hospital General Universitario Gregorio Maranon, Madrid, 
      Spain.
FAU - Lopez-Baena, Jose A
AU  - Lopez-Baena JA
AD  - Department of Surgery, Hospital General Universitario Gregorio Maranon, Madrid, 
      Spain.
FAU - Maruszewski, Przemyslaw
AU  - Maruszewski P
AD  - Department of Pediatric Surgery and Organ Transplantation, Children s Memorial 
      Health Institute, Warsaw, Poland.
FAU - Banares, Rafael
AU  - Banares R
AD  - Hepatology and Liver Transplant Unit, Department of Digestive Diseases, Hospital 
      General Universitario Gregorio Maranon, Madrid, Spain.
AD  - Instituto de Investigacion Sanitaria of Hospital General Universitario Gregorio 
      Maranon (IiSGM), Madrid, Spain.
AD  - Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas 
      (CIBEREHD), Madrid, Spain.
AD  - Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
FAU - Perez-Pena, Jose M
AU  - Perez-Pena JM
AD  - Department of Anesthesiology and Intensive Care, Hospital General Universitario 
      Gregorio Maranon, Madrid, Spain.
AD  - Instituto de Investigacion Sanitaria of Hospital General Universitario Gregorio 
      Maranon (IiSGM), Madrid, Spain.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20200408
PL  - United States
TA  - Liver Transpl
JT  - Liver transplantation : official publication of the American Association for the 
      Study of Liver Diseases and the International Liver Transplantation Society
JID - 100909185
RN  - 0 (Biomarkers)
RN  - 0 (Troponin)
RN  - 0 (Troponin T)
SB  - IM
MH  - Adult
MH  - Biomarkers
MH  - Humans
MH  - *Liver Transplantation/adverse effects
MH  - Postoperative Period
MH  - Prospective Studies
MH  - *Troponin
MH  - Troponin T
EDAT- 2020/01/17 06:00
MHDA- 2021/03/19 06:00
CRDT- 2020/01/17 06:00
PHST- 2019/09/30 00:00 [received]
PHST- 2020/01/09 00:00 [accepted]
PHST- 2020/01/17 06:00 [pubmed]
PHST- 2021/03/19 06:00 [medline]
PHST- 2020/01/17 06:00 [entrez]
AID - 10.1002/lt.25716 [doi]
PST - ppublish
SO  - Liver Transpl. 2020 May;26(5):681-692. doi: 10.1002/lt.25716. Epub 2020 Apr 8.