Abstract P025: Atrial Fibrillation Associated With Worsened Postoperative Outcomes In Patients Undergoing Orthotropic Liver Transplantation.

Abstract

Introduction: Pre-orthotropic liver transplant (OLT) cardiac risk assessment commonly focuses on evaluation of coronary artery disease (CAD). However, the effect of atrial fibrillation (AF) on post-OLT outcomes is less well known. In this study, we sought to evaluate the prevalence and effect of pre-transplant AF on 30-day post-operative outcomes in patients undergoing OLT. Methods: The National Inpatient Sample Database was queried from 2011 to 2017 for relevant ICD-9 and -10 procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes were compared in patients who underwent OLT with AF and those without. Results: Among 45,357 patients who underwent OLT, 35.8 % were women. The prevalence of AF prior to transplant was 2,932 (6.5%) with a trend towards increasing prevalence between 2011 and 2017 with an annual change rate of 4.19%, see Figure 1. Compared to the non-AF cohort, the AF group was older (59.9±7.9 vs 51.2±16.9 years old, p<0.001), with a higher prevalence of diabetes mellitus (DM), CAD, chronic kidney disease, heart failure (HF), anemia, and thrombocytopenia (p<0.001 for all). In-hospital 30-day mortality (5.8% vs. 3.6%, p<0.001), intra-operative cardiac arrest (8.1% vs. 1.7%, p<0.001), post-operative ventricular tachycardia (7.5% vs. 2.6%, p<0.001) and acute kidney injury (64.2% vs. 49.3%, p<0.001) were higher in the AF group when compared to those without. Using a multivariate logistic regression model to adjust for confounding factors, AF was still predictive of an increased odds of in-hospital 30-day mortality (OR: 1.92; 95% CI [1.61-2.30], p<0.001). Conclusion: In patients undergoing OLT, pre-transplant AF is increasing in prevalence and appears to be associated with worse in-hospital outcomes and 30-day mortality. This effect may be driven in part by a higher prevalence of concurrent cardiovascular disease and associated risk factors in patients with AF. Greater emphasis should be placed on AF in the preoperative cardiovascular risk stratification of patients undergoing OLT.