간이식 환자에서 수술 전 대동맥 확장도의 특징과 수술 후 사망률에 미치는 영향

Abstract

Introduction: Aortic distensibility (AD) is one of the earliest detectable manifestations of structural alterations of the aorta in various conditions. Patients with impaired liver function had characteristic properties of blood vessels, such as systemic vasodilation and decrease of systemic vascular resistance. This study investigated characteristics of AD in liver transplantation (LT) candidates, and its effect on all-cause mortality after LT.

Patients and methods: In this study, a total of 646 consecutive LT candidates were included. AD was measured retrospectively by B-mode transthoracic echocardiography on parasternal long-axis view using “image-J” software. LT candidates were categorized according to low (<3.13 cm2·dyn-1·10-6) and high (≥3.13 cm2·dyn-1·10-6) AD groups. Survival analysis was performed using Kaplan-Meier method. All-cause mortality based on AD value was investigated using Cox proportional hazard regression model. To investigate the risk factors related to low AD in LT candidates, multivariate logistic regression was performed.

Results: Over 47-month median follow-up period, 94 patients (13.9%) expired after LT. LT recipients with low AD (n = 254) group had higher mortality rate than high AD (n = 422) group (29.5% vs. 4.5%, Log-rank p <0.001), and was independently associated with risk of mortality (hazard ratio, 6.55; 95% CI, 3.99−10.76; p <0.001). The risk factors related low AD were age, body mass index, mean arterial pressure, left ventricular ejection fraction, QTc interval, and C-reactive protein.

Conclusions: This study suggested that LT candidates with low AD (<3.13 cm2·dyn-1·10-6) had significantly higher risk in all-cause mortality, and proposes that non-invasive and relatively simple measurement of AD by echocardiography may serve an additional prognostic index for survival after LT.