Di-san junyi daxue xuebao (Dec 2019)
Effects of preoperative beta blockers on intraoperative circulation management and short-term myocardial injury and stroke after liver transplantation: a propensity-matched study
Abstract
Objective To retrospectively analyze the effect of preoperative use of β-blockers on blood transfusion volume, use of pressor drugs, post-reperfusion syndrome, and incidence of heart muscle injury and stroke within 30 d after operation during liver transplantation (LT) by a propensity-matched study. Methods A retrospective study was performed on the patients who underwent LT at UCLA Ronald Reagan medical center between October 2005 and September 2014 after the approval of the Institutional Review Board of the university (IRB#11-003058). According to the preoperative use of β-blockers or not, these patients were divided into β-blockers group (n=643) and non β-blockers group (n=809). The difference of preoperative variables between the 2 groups was analyzed by single factor analysis. The variables with a value of P < 0.05 and those of important relevant clinical status were selected in a logistic regression model to generate a propensity score for each patient. The patients in 2 groups were matched in 1: 1 with the nearest propensity scores. The amount of blood transfusion, use of vasopressors, incidence of post-reperfusion syndrome, and occurrence of myocardial injury and stroke within 30 d after LT were compared between the 2 groups. Results Based on the clinical data of 2 102 patients recruited in this study, single factor analysis showed that the patients of the β-blocker group were significantly older, larger proportion of males, and higher incidences of hypertension, coronary artery disease, diabetes, and gastrointestinal bleeding. The results of logistic regression analysis eliminated after propensity match (442 patients in each group, totally 884 patients) indicated that there were no significant differences in the amount of intraoperative blood transfusion (18.8±16.1 vs 20.3±18.0 U, P=0.155), administration of vasopressors (77.4% vs 79.0%, P=0.556), incidence of post-reperfusion syndrome (14.7% vs 14.9%, P=0.901), and occurrence of myocardial injury (3.8% vs 4.3%, P=0.761) and stroke (0.7% vs 2.0%, P=0.143) within 30 d after LT between the 2 matched groups. Conclusion Preoperative use of β-blockers for over 7 d has no effect on amount of blood transfusion, use of vasopressors, incidence of post-reperfusion syndrome, and occurrence of myocardial injury and stroke within 30 d after LT. The drug can be continuously administered for the patients with end-stage liver disease before undergoing LT
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