Effect of QT interval prolongation on cardiac arrest following liver transplantation and derivation of a risk index

Anoop N. Koshy, Jefferson Ko, Omar Farouque, Shamil D. Cooray, Hui Chen Han, Benjamin Cailes, Paul J. Gow, Laurence Weinberg, Adam Testro, Han S. Lim, Andrew W. Teh

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4 Citations (Scopus)

Abstract

Liver transplantation (LT) has a 4-fold higher risk of periprocedural cardiac arrest and ventricular arrhythmias (CA/VAs) compared with other noncardiac surgeries. Prolongation of the corrected QT interval (QTc) is common in patients with liver cirrhosis. Whether it is associated with an increased risk of CA/VAs following LT is unclear. Rates of 30-day CA/VAs post-LT were assessed in consecutive adults undergoing LT between 2010 and 2017. Pretransplant QTc was measured by a cardiologist blinded to clinical outcomes. Among 408 patients included, CA/VAs occurred in 26 patients (6.4%). QTc was significantly longer in CA/VA patients (475 ± 34 vs 450 ± 34 ms, P <.001). Optimal QTc cut-off for prediction of CA/VAs was ≥480 ms. After adjustment, QTc ≥480 ms remained the strongest predictor for the occurrence of CA/VAs (odds ratio [OR] 5.2, 95% confidence interval [CI] 2.2-12.6). A point-based cardiac arrest risk index (CARI) was derived with the bootstrap method for yielding optimism-corrected coefficients (2 points: QTc ≥480, 1 point: Model for End-Stage Liver Disease [MELD] ≥30, 1 point: age ≥65, and 1 point: male). CARI score ≥3 demonstrated moderate discrimination (c-statistic 0.79, optimism-corrected c-statistic 0.77) with appropriate calibration. QTc ≥480 ms was associated with a 5-fold increase in the risk of CA/VAs. The CARI score may identify patients at higher risk of these events. Whether heightened perioperative cardiac surveillance, avoidance of QT prolonging medications, or beta blockers could mitigate the risk of CA/VAs in this population merits further study.

Original languageEnglish
Number of pages11
JournalAmerican Journal of Transplantation
DOIs
Publication statusAccepted/In press - 6 Jun 2020

Keywords

  • anesthesia/pain management
  • cardiovascular disease
  • cirrhosis
  • clinical research/practice
  • heart disease
  • liver disease
  • liver transplantation/hepatology
  • liver transplantation: split

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