Atrial Fibrillation in Patients Undergoing Liver TransplantationdA Single-Center Experience A. Vannucci a , R. Rathor a , N. Vachharajani b , W. Chapman b , and I. Kangrga a, * Departments of a Anesthesiology and b Surgery, Washington University School of Medicine, St Louis, Missouri ABSTRACT Background. As the prevalence of atrial fibrillation rises with age and older patients increasingly receive transplants, the perioperative management of this common arrhythmia and its impact on outcomes in liver transplantation is of relevance. Methods. Retrospective review of 757 recipients of liver transplantation from January 2002 through December 2011. Results. Nineteen recipients (2.5%) had documented pre-transplantation atrial fibrillation. Sixteen patients underwent liver and 3 a combined liver-kidney transplantation. Three patients died within 30 days (84.2% 1-month survival) and another 3 within 1 year of transplantation (68.4% 1-year survival). Compared with patients without atrial fibrillation, the relative risk of death in the atrial fibrillation group was 5.29 at 1 month (P ¼ .0034; 95% confidence interval [CI], 1.73e16.18) and 3.28 at 1 year (P ¼ .0008; 95% CI, 1.63e6.59). Time to extubation and intensive care unit (ICU) and hospital readmissions were not different from the control cohort. Rapid ventricular response requiring treatment occurred in 4 patients during surgery and 7 after surgery, resulting in 3 ICU and 3 hospital readmissions. Conclusions. The results suggest that patients with atrial fibrillation may be at increased risk of mortality after liver transplantation. Optimization of medical therapy may decrease ICU and hospital readmission due to rapid ventricular response. P ATIENTS 50 years are the fastest growing age group of liver transplant (LT) recipients [1]. More than 70% (4,473) of 6,341 patients who received LT in the United States in 2011 were 50 years old and almost 12% (745) were 65 years oldda 2-fold increase from 2001 (6.5%, 339 of 5,195 patients) [1]. Although elderly patients have good perioperative outcomes, this cohort also has an increased risk of cardiovascular comorbidities, primarily hypertension, coronary artery disease, and arrhythmias [2,3]. If these trends continue, more LT candidates will be at risk of atrial fibrillation (AF) [4e7]. AF is the most common sustained cardiac arrhythmia in Europe and the United States, with a prevalence of 1%e2% in the general population [4,8,9]. AF prevalence increases with age, ranging from 0.5% in the 6th decade to almost 9% in octogenarians [10]. Similar trends have been reported in other parts of the world [11]. AF has been reported as a complication of LT [12e16], and a recent retrospective study suggests that patients with preexisting AF may have worse patient and graft survivals after LT [17]. We report our institutional experience with 19 patients with a preoperative diagnosis of AF who received either liver or combined liver-kidney transplants. METHODS Selection and Description of Participants This was a retrospective cohort study evaluating the outcomes of adult LT recipients with documented pre-transplantation AF. After Institutional Review Board approval, we reviewed the records of patients who underwent LT at our institution from January 1, 2002, to December 31, 2011. We included patients who presented with a documented preoperative diagnosis of AF. *Address correspondence to Ivan Kangrga, MD, PhD, 660 S Euclid Ave, Box 8054, St Louis, MO 63110. E-mail: kangrgai@ anest.wustl.edu 0041-1345/14/$esee front matter http://dx.doi.org/10.1016/j.transproceed.2014.02.020 ª 2014 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 1432 Transplantation Proceedings, 46, 1432e1437 (2014)