Liver transplantation and atrial fibrillation: A meta-analysis

Abstract

AIMTo assess prevalence of pre-existing atrial fibrillation (AF) and/or incidence of AF following liver transplantation, and the trends of patient’s outcomes overtime; to evaluate impact of pre-existing AF and post-operative AF on patient outcomes following liver transplantation.METHODSA literature search was conducted utilizing MEDLINE, EMBASE and Cochrane Database from inception through March 2018. We included studies that reported: (1) prevalence of pre-existing AF or incidence of AF following liver transplantation; or (2) outcomes of liver transplant recipients with AF. Effect estimates from the individual study were extracted and combined utilizing random-effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews, No. CRD42018093644).RESULTSTwelve observational studies with a total of 38586 liver transplant patients were enrolled. Overall, the pooled estimated prevalence of pre-existing AF in patients undergoing liver transplantation was 5.4% (95%CI: 4.9%-5.9%) and pooled estimated incidence of AF following liver transplantation was 8.5% (95%CI: 5.2%-13.6%). Meta-regression analyses were performed and showed no significant correlations between year of study and either prevalence of pre-existing AF (P = 0.08) or post-operative AF after liver transplantation (P = 0.54). The pooled OR of mortality among liver transplant recipients with pre-existing AF was 2.34 (2 studies; 95%CI: 1.10-5.00). In addition, pre-existing AF is associated with postoperative cardiovascular complications among liver transplant recipients (3 studies; OR: 5.15, 95%CI: 2.67-9.92, I2 = 64%). With limited studies, two studies suggested significant association between new-onset AF and poor clinical outcomes including mortality, cerebrovascular events, post-transplant acute kidney injury, and increased risk of graft failure among liver transplant recipients (P < 0.05).CONCLUSIONThe 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.

Redefining Cirrhotic Cardiomyopathy for the Modern Era

“…Atrial fibrillation is common in ESLD and increases with increasing Model for End‐Stage Liver Disease score . Atrial fibrillation and other dysrhythmias have been associated with increased cardiovascular events in the perioperative period and worse long‐term outcomes …”

“…(58) Atrial fibrillation and other dysrhythmias have been associated with increased cardiovascular events in the perioperative period and worse long-term outcomes. (59,60)…”

Safety and efficacy of catheter ablation for atrial fibrillation in abdominal solid organ (renal and hepatic) transplant recipients: a single-center pilot experience

“…AF is common in abdominal solid-organ transplant recipients 11 . Previous studies have demonstrated that the prevalence of preexisting AF in renal and hepatic transplant recipients is 7.0% and 5.6%, respectively, and that the incidence of AF after kidney and liver transplantation is 4.9% and 8.5%, respectively 7,8 . The high prevalence of AF may mean that patients receiving kidney or liver transplants appear to be at higher risk [22][23][24] .…”

“…These epidemiological estimates could be extended to organ transplant recipients. Studies show that end-stage renal disease and end-stage hepatic disease patients who receive organ grafting have an AF prevalence of 7.0% and 5.6%, respectively, and these values are higher than that of the general population (1%-2%) [5][6][7][8] . In addition, studies have demonstrated pooled incidences of post-kidney transplant AF and post-liver transplant AF of 4.9% and 8.5%, respectively 7,8 .…”

Safety and efficacy of catheter ablation for atrial fibrillation in abdominal solid organ (renal and hepatic) transplant recipients: A single‐center pilot experience

“…Studies show that end-stage renal disease and endstage hepatic disease patients who receive organ grafting have an AF prevalence of 7.0% and 5.6%, respectively, and these values are higher than that of the general population (1%-2%). [5][6][7][8] In addition, studies have demonstrated pooled incidences of postkidney transplant AF and postliver transplant AF of 4.9% and 8.5%, respectively. 7,8 Because of ongoing improvements in surgery and medicine, the number of organ transplant patients is steadily increasing.…”