Atrial Fibrillation in the Perioperative Period of Liver Transplantation: An Integrative Review

Authors

Keywords:

Atrial Fibrillation, Liver Transplantation, Intraoperative Period, Postoperative Period

Abstract

Objective: To review the development of atrial fibrillation (AF) during the perioperative period (intraoperative and postoperative) in liver transplant recipients. Methods: This integrative review sought to analyze the emergence of AF in the perioperative period of liver transplantation and its associated factors. The following databases were used: PubMed, MEDLINE, SciELO, and Scopus. The descriptors were interchanged using the boolean operator “AND”, with a time restriction of 10 years, in English and Portuguese. Initially, 305 articles were found, of which nine met the proposed objective after analysis. Results: In this review, nine articles were selected, categorized according to the onset of AF concerning liver transplant surgery: three concerning the onset of AF in the intraoperative period and six in the postoperative period. During the intraoperative period, cases of AF had a higher incidence after reperfusion of the liver graft. In addition, the group with AF had a higher incidence of liver failure, a higher model for endstage liver disease (MELD) scores, higher serum total bilirubin concentrations, and increased international normalized ratio (INR) values. AF in the postoperative period was associated with older patients, higher MELD scores, and renal dysfunction. Hospital stay was prolonged, and the risk of mortality was increased in patients with postoperative AF. Conclusion: The appearance of AF in the perioperative period of liver transplantation suggests a correlation with patients with higher MELD scores, advanced age, and instability during surgery and may indicate a poor prognosis for the patient.

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References

Vannucci A, Rathor R, Vachharajani N, Chapman W, Kangrga I. Atrial fibrillation in patients undergoing liver transplantation-a single-center experience. Transplant Proc 2014; 46(5): 1432-7. https://doi.org/10.1016/j.transproceed.2014.02.020

Bhave PD, Goldman LE, Vittinghoff E, Maselli J, Auerbach A. Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery. Am Heart J 2012; 164(6): 918-24. https://doi.org/10.1016/j.ahj.2012.09.004

Wilke T, Groth A, Mueller S, Pfannkuche M, Verheyen F, Linder R, et al. Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. EP Eur 2013; 15(4): 486-93. https://doi.org/10.1093/europace/eus333

Kornej J, Börschel C, Benjamin EJ, Schnabel RB. Epidemiology of atrial fibrillation in the 21st century, novel methods and new insights. Circ Res 2020; 127(1): 4-20. https://doi.org/10.1161/CIRCRESAHA.120.316340

Xia VW, Worapot A, Huang S, Dhillon A, Gudzenko V, Backon A, et al. Postoperative atrial fibrillation in liver transplantation. Am J Transplant 2015; 15(3): 687-94. https://doi.org/10.1111/ajt.13034

Koshy AN, Enyati A, Weinberg L, Han H-C, Horrigan M, Gow P, et al. Postoperative atrial fibrillation and longterm risk of stroke in patients undergoing liver transplantation. Stroke 2021; 52(1): 111-20. https://doi.org/10.1161/STROKEAHA.120.031454

Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021; 372: n160. https://doi.org/10.1136/bmj.n160

Prakash K, Karna ST, Pandey CK. Atrial fibrillation during anhepatic phase liver transplantation: now what? J Anaesthesiol Clin Pharmacol 2019; 35(2): 269-71. https://doi.org/10.4103/joacp.JOACP_234_17

Li X, Wang X, Guan Z. New onset atrial fibrillation during orthotopic liver transplantation induced by iced saline injection for transpulmonary thermodilution: a case report. J Int Med Res 2022; 50(10): 03000605221132711. https://doi.org/10.1177/03000605221132711

Moon Y-J, Kwon H-M, Park Y-S, Kim S-H, Hwang G-S. Brief episodes of newly developed intraoperative atrial fibrillation predicts worse outcomes in adult liver transplantation. Transplant Proc 2018; 50(4): 1142-6. https://doi.org/10.1016/j.transproceed.2018.01.039

Nicolau-Raducu R, Gitman M, Ganier D, Loss GE, Cohen AJ, Patel H, et al. Adverse cardiac events after orthotopic liver transplantation: a cross-sectional study in 389 consecutive patients. Liver Transpl 2015; 21(1): 13-21. https://doi.org/10.1002/lt.23997

Rivas E, Sasaki K, Liang C, Wang J, Quintini C, Maheshwari K, et al. New-onset atrial fibrillation in patients undergoing liver transplantation: retrospective analysis of risk factors and outcomes. J Cardiothorac Vasc Anesth 2022; 36(11): 4100-7. https://doi.org/10.1053/j.jvca.2022.07.013

Rachwan RJ, Kutkut I, Hathaway TJ, Timsina LR, Kubal CA, Lacerda MA, et al. Postoperative atrial fibrillation and flutter in liver transplantation: an important predictor of early and late morbidity and mortality. Liver Transpl 2020; 26(1): 34-44. https://doi.org/10.1002/lt.25631

Molinari M, Sood P, Samra PB, Tevar A, Ganoza A, Jonassaint N, et al. Atrial fibrillation in renal or liver transplant recipients: a systematic review and meta-analysis. Transplant Rev 2019; 33(1) 29-38. https://doi.org/10.1016/j.trre.2018.07.003

Rocha Filho JA. Efeitos da solução salina hipertônica na reperfusão hepática em pacientes submetidos ao transplante do fígado. Thesis [PhD in Anestesiology] – Universidade de São Paulo; 2006. https://doi.org/10.11606/T.5.2006.tde-22032006-202604

Shen J, Lall S, Zheng V, Buckley P, Damiano RJ, Schuessler RB. The persistent problem of new onset postoperative atrial fibrillation: a single institution experience over two decades. J Thorac Cardiovasc Surg 2011; 141(2): 559-70. https://doi.org/10.1016/j.jtcvs.2010.03.011

Jiang S, Liao X, Chen Y, Li B. Exploring postoperative atrial fibrillation after non-cardiac surgery: mechanisms, risk factors, and prevention strategies. Front Cardiovasc Med 2023; 10: 1273547. https://doi.org/10.3389/fcvm.2023.1273547

Mozos I. Arrhythmia risk in liver cirrhosis. World J Hepatol 2015; 7(4): 662-72. https://doi.org/10.4254/wjh.v7.i4.662

Joshi KK, Tiru M, Chin T, Fox MT, Stefan MS. Postoperative atrial fibrillation in patients undergoing non-cardiac nonthoracic surgery: a practical approach for the hospitalist. Hosp Pract 2015: 43(4): 235-44. https://doi.org/10.1080/21548331.2015.1096181

Huang WA, Dunipace EA, Sorg JM, Vaseghi M. Liver disease as a predictor of new-onset atrial fibrillation. J Am Heart Assoc Cardiovasc Cerebrovasc Dis 2018; 7(15): e008703. https://doi.org/10.1161/JAHA.118.008703

Lee H, Choi E-K, Rhee T-M, Lee S-R, Lim W-H, Kang S-H, et al. Cirrhosis Is a risk factor for atrial fibrillation: a nationwide, population-based study. Liver Int 2017; 37(11): 1660-7. https://doi.org/10.1111/liv.13459

Published

2024-07-11

How to Cite

Cardoso, R. M. V., & Fonseca Neto, O. C. L. da. (2024). Atrial Fibrillation in the Perioperative Period of Liver Transplantation: An Integrative Review. Brazilian Journal of Transplantation, 27. Retrieved from https://bjt.emnuvens.com.br/revista/article/view/601

Issue

Section

Review Article