Preoperative cardiac troponin level is associated with all-cause mortality of liver transplantation recipients

<div><p>This study was aimed to evaluate the association between preoperative high-sensitivity cardiac troponin I (hs-cTnI) level and mortality in patients undergoing liver transplantation (LT). From January 2011 to May 2016, preoperative hs-cTnI level was measured in consecutive 487 patients scheduled for LT. Patients with elevated preoperative hs-cTnI were compared with those who had normal level. The primary outcome was all-cause death in follow-up period of 30 days to 1 year after operation. Of the 487 patients, 58 (11.9%) had elevated preoperative hs-cTnI and 429 (88.1%) had normal preoperative hs-cTnI. In multivariate analysis, the rate of 1-year mortality and 30-day mortality were higher in elevated preoperative hs-cTnI group (hazard ratio [HR], 3.69; confidence interval [CI] 95%, 1.83–7.42; p < 0.001, HR, 6.61; CI, 1.91–22.82; p = 0.003, respectively). After adjustment with inverse probability weighting (IPW), the incidence of 1-year mortality and 30-day mortality were higher in elevated group (HR, 4.66; CI, 3.56–6.1; p < 0.001, HR, 10.31; CI, 6.39–16.66; p < 0.001, respectively). In conclusion, this study showed that in patients who underwent LT, elevation of preoperative hs-cTnI level was associated with 1-year mortality and 30-day mortality.</p></div

The Kaplan-Meier Curves for the hs-cTnI elevated and normal hs-cTnI group.

<p>Curves for (A) all-cause death in 1-year, and (B) all-cause death in 30 days.</p

Subgroup analysis of deceased donor type, diabetes mellitus, encephalopathy, preoperative transfusion, intraoperative dopamine use and intraoperative norepinephrine use for all-cause death in 1-year.

<p>Subgroup analysis of deceased donor type, diabetes mellitus, encephalopathy, preoperative transfusion, intraoperative dopamine use and intraoperative norepinephrine use for all-cause death in 1-year.</p

Baseline characteristics.

<p>Baseline characteristics.</p

Preoperative variables associated with clinical outcome.

<p>Preoperative variables associated with clinical outcome.</p

Oral Valganciclovir as a Preemptive Treatment for Cytomegalovirus (CMV) Infection in CMV-Seropositive Liver Transplant Recipients

<div><p>Objectives</p><p>Cytomegalovirus (CMV) infections in liver transplant recipients are common and result in significant morbidity and mortality. Intravenous ganciclovir or oral valganciclovir are the standard treatment for CMV infection. The present study investigates the efficacy of oral valganciclovir in CMV infection as a preemptive treatment after liver transplantation.</p><p>Methods</p><p>Between 2012 and 2013, 161 patients underwent liver transplantation at Samsung Medical Center. All patients received tacrolimus, steroids, and mycophenolate mofetil. Patients with CMV infection were administered oral valganciclovir (VGCV) 900mg/day daily or intravenous ganciclovir (GCV) 5mg/kg twice daily as preemptive treatment. Stable liver transplant recipients received VGCV.</p><p>Results</p><p>Eighty-three patients (51.6%) received antiviral therapy as a preemptive treatment because of CMV infection. The model for end-stage liver disease (MELD) score and the proportions of Child-Pugh class C, hepatorenal syndrome, and deceased donor liver transplantation in the CMV infection group were higher than in the no CMV infection group. Sixty-one patients received GCV and 22 patients received VGCV. The MELD scores in the GCV group were higher than in the VGCV group, but there were no statistical differences in the pretransplant variables between the two groups. AST, ALT, and total bilirubin levels in the GCV group were higher than in the VGCV group when CMV infection occurred. The incidences of recurrent CMV infection in the GCV and VGCV groups were 14.8% and 4.5%, respectively (P=0.277).</p><p>Conclusion</p><p>Oral valganciclovir is feasible as a preemptive treatment for CMV infection in liver transplant recipients with stable graft function.</p></div

Baseline characteristics of patients with and without CMV infection.

<p>CMV, cytomegalovirus; BMI, body mass index; MELD, model for end-stage liver disease; DDLT, deceased donor liver transplantation; ICU, intensive care unit</p><p>Baseline characteristics of patients with and without CMV infection.</p

Clinical characteristics of patients who received intravenous GCV and oral VGCV.

<p>GCV, ganciclovir; VGCV, valganciclovir; BMI, body mass index; MELD, model for end-stage liver disease; DDLT, deceased donor liver transplantation; ICU, intensive care unit</p><p>Clinical characteristics of patients who received intravenous GCV and oral VGCV.</p

(A) Graft survival and (B) patient survival stratified according to antiviral agent use.

<p>The 1-year and 2-year survival rates of patients with CMV infection and patients without CMV infection were 86.7%% vs. 92.3% and 84.2% vs. 92.3%, respectively (<i>P</i> = 0.218). With respect to antiviral agents, the 1-year and 2-year survival rates of the intravenous GCV and the oral VGCV groups were 95.5% vs. 83.6% and 86.8% vs. 83.6%, respectively (<i>P</i> = 0.365)</p

Clinical characteristics between intravenous GCV and oral VGCV.

<p>GCV, ganciclovir; VGCV, valganciclovir; AST, aspartate transaminase; ALT, alanine transaminase; ALP, alkaline phosphatase; LT, liver transplantation; CMV, cytomegalovirus</p><p>Clinical characteristics between intravenous GCV and oral VGCV.</p