Significance of changes in serum troponin and myocardial enzymes in children with living donor liver transplantation

Abstract

Objective To explore the characteristics and its clinical significance of troponin I (cTnI), myocardial enzymes and intraoperative hemodynamic changes in the pediatric patients undergoing living donor liver transplantation. Methods Liver transplantation was performed in 50 congenital biliary atresia children who were ranged from grade Ⅲ or Ⅳ in Tianjin First Central Hospital from January 2013 to December 2014 according to the American Society of Anesthesiologists (ASA), meanwhile, the method of the combined intravenous-inhalation anesthesia was applied during operation.Blood samples were drawn from central vein before skin incision (T0 baseline), at 30 min of anhepatic phase (T1), 30 min of neohepatic phase (T2), and 12 h, 36 h after operation (T3, T4). Levels of cTnI, creatine kinase (CK), lactate dehydrogenase (LDH)and α-hydroxy butyric acid dehydrogenase (α-HBDH) were mearsured, respectively.Furthermore, heart rate(HR), mean arterial blood pressure(MAP), central venous pressure(CVP) and arterial blood gas analysis[pH value, pa(O2), pa(CO2), and base excess(BE)] were monitored at the moment of T0, T1, T2 as well as the end of surgery. Results The levels of cTnI, CK, LDH and α-HBDH in T1-T3 were increased, and there was a peak at the T2 compared with the baseline at T0 (all P<0.05). At T3 and T4, cTnI, CK, LDH and α-HBDH levels significantly decreased compared with those at T2 (all P<0.05), the levels of cTnI were (0.06±0.02) μg/L, (0.37±0.52) μg/L, (0.05±0.02) μg/L, CK levels were (344.6±209.5)U/L, (466.1±116.4)U/L, (219.3±111.5)U/L, LDH levels were (552.3±414.9)U/L, (966.4±454.1)U/L, (322.8±108.8)U/L, and α-HBDH levels were (301.6±124.0)U/L, (456.4±168.4)U/L, (146.2±80.2)U/L, respectively.The levels of hemodynamics significantly changed in anhepatic phase and neohepatic phase.Compared with T0: T1, HR accelerated, MAP, CVP decreased, BE value increased, and the differences were statistically significant (all P<0.05); T2, open vena cava and back to the blood volume surge, CVP, MAP increased, HR decreased but still higher than T0, BE value further increased, and the differences were statistically significant (all P<0.05). After the surgery, various hemodynamic indexes fell to preoperative levels, the levels of HR were (103.1±5.9) times/min, (128.8±8.5) times/min, (115.1±0.3) times/min, (103.5±5.9) times/min, MAP levels were (59.7±9.1) kPa, (48.7±5.4) kPa, (58.6±7.1) kPa, (59.1±8.6) kPa, CVP levels were (7.5±4.3) kPa, (3.9±4.6) kPa, (5.8±3.5) kPa, (7.2±4.1) kPa, BE levels were (-1.5±5.0) mmol/L, (-0.4±5.7) mmol/L, (1.0±3.8) mmol/L, (2.4±2.2) mmol/L, respectively. Conclusions The myocardial injury may appear during the perioperation of pediatric living donor liver transplantation and gradually aggravated during the anhepatic phase.The worst injury peaks at 12h and it gradually returns to the preoperative level 36 h postoperativelly. Key words: Liver transplantation; Troponin; Myocardial enzyme; Hemodynamic; Infant