Preoperative beta blockade and severe intraoperative bradycardia in liver transplantation

Abstract

Nonselective Beta blockade (NSBB) is commonly prescribed for liver transplantation (LT) candidates, but its impact on intraoperative hemodynamics is not well understood. In this study, we investigated if preoperative NSBB was associated with severe bradycardia during LT and if severe intraoperative bradycardia was associated with 30‐day mortality. Adult patients undergoing LT between 2005 and 2014 were included. Propensity matching was used to control selection bias. Intraoperative hemodynamics were compared between patients with and without preoperative NSBB. Univariate and multivariate methods were used in statistical analysis. Of 1452 patients, 370 who received preoperative NSBB were matched in a 1:1 ratio with those who did not. Propensity matching eliminated all significant differences between the two groups. Patients who received preoperative NSBB had a significantly higher incidence of severe intraoperative bradycardia compared with the non‐BB group (9.6% vs 3.2%, P = 0.001, OR 2.95, 95% CI 1.42‐6.12, P = 0.004). Intraoperative hypotension and postreperfusion syndrome were not significantly different between the two groups. Severe intraoperative bradycardia was associated with increased 30‐day mortality. In conclusion, preoperative NSBB was associated with severe intraoperative bradycardia in LT. In patients who receive preoperative NSBB, severe intraoperative bradycardia should be closely monitored in LT. Further studies assessing safety of preoperative NSBB and intraoperative bradycardia in LT are warranted.

Intraoperative Hypotension and 30-D Mortality After Liver Transplantation

“…Preoperatively administered beta-blockade may contribute to the development of IOH during LT surgery; however, it has not been associated with postoperative mortality in LT patients. 15 A good understanding of the degree and duration of hypotension that are associated with mortality has important clinical implications. When IOH reaches a dangerously low level, prompt treatment is necessary.…”

“…Preoperatively administered beta-blockade may contribute to the development of IOH during LT surgery; however, it has not been associated with postoperative mortality in LT patients. 15 …”

Pretransplant left ventricular hypertrophy in association with postoperative myocardial injury in liver transplantation

“…Beta blocker has been widely used to treat variceal bleeding in LT patients. From a cardiac standpoint, beta blocker significantly reduced postoperative myocardial infarction risk, but it also increases intraoperative bradycardia, postoperative stroke, and mortality . Intraoperative hypotension is associated with PMI, acute kidney injury, and death; therefore, severe and prolonged hypotension should be avoided during LT. Because LT patients usually have low systemic vascular resistance, the cutoff values of hypotension may be different compared with those undergoing noncardiac surgery.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2018

“…Although intraoperative hypotension and postreperfusion syndrome (PRS) did not significantly differ between the 2 groups, severe intraoperative bradycardia was associated with increased 30-day mortality. 58 Left Ventricular Contractility. Contractility of the left ventricle is increased with ESLD severity.…”

“…Use of perioperative β-blockers may significantly affect the development of bradycardia during LT and may relate to a poor outcome. Fu et al 58 at UCLA performed a propensity-matched study on 1452 patients undergoing LT between 2005 and 2014. They matched 370 LT patients who received preoperative nonselective β-blockers at a 1:1 ratio with those who did not.…”