Evaluation of Elevated Liver Enzymes and their Association with Increased Risk of Perioperative Mortality in Heart Transplant Patients

Amin Sadrinezhad; Alireza Jahangirifard; Ali Pirsalehi; Saeed Abdi; Seyedeh Nazanin Mansouri Gilani; Habib Emami

doi:10.18502/jimc.v6i2.12235

Amin Sadrinezhad Department of Internal Medicine, School of Medicine, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Alireza Jahangirifard Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
Ali Pirsalehi Department of Internal Medicine, School of Medicine, Ayatollah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Saeed Abdi Research Institute for Gastroenterology and Liver Diseases Shahid Beheshti University of Medical Sciences, Tehran, Iran
Seyedeh Nazanin Mansouri Gilani Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
Habib Emami Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran

DOI: https://doi.org/10.18502/jimc.v6i2.12235

Keywords: Heart transplant surgery, Liver disorders, Liver enzymes, Perioperative mortality

Abstract

Background: Cardiovascular disease, which itself can lead to liver disorders, is known as the most common cause of death in many countries, including Iran. Elevated liver enzymes can increase mortality risk after transplantation in most heart surgeries. This study aimed to investigate the effect of elevated liver enzymes before and after transplantation on the risk of perioperative mortality in heart transplant patients.

Methods: The information of this historical cohort study was prepared using patients’ hospital records from 2014 to 2019. The data belonged to demographic information, medical history, and laboratory data of 203 patients admitted to Dr. Masih Daneshvari Hospital. More than three times normal institutional ranges defined elevated liver enzymes. Also, the number of deaths within 30 days after transplantation was considered to determine perioperative mortality. The Chi-square test and regression method were used to analyze the data using SPSS software.

Results: Mortality of patients with elevated liver enzymes before and on the first, second, and third days after heart transplantation was 4.08, 3.95, 3.75, and 4.89 times higher than those with normal liver enzymes, respectively. Increasing the Model for End-Stage Liver Disease (MELD) score was associated with a significantly increased risk of death (p<0.001).

Conclusion: Elevated liver enzymes before or three days after heart transplantation are significantly associated with perioperative transplant death. Optimization of liver function before transplantation can play an important role in preventing mortality.