Intraoperative hypotension during liver transplantation is associated with long-term mortality

Intraoperative hypotension (IOH) is common during liver transplantation (LT); however, its impact on long-term mortality remains unclear. We investigated the association between IOH and 1-year mortality using various mean arterial pressure (MAP) thresholds and exposure durations.

This retrospective observational cohort study included 1063 patients who underwent LT. We defined IOH as an MAP < 65 mmHg and examined each threshold in 5 mmHg increments to < 40 mmHg. Our primary outcome was 1-year mortality after LT. Multivariate logistic regression was used to control for confounding variables while assessing the association between IOH and 1-year mortality.

The 1-year mortality after LT was 7.1%. Only moderate-to-severe IOH showed independent associations with 1-year mortality: MAP < 55 mmHg for ≥ 43 minutes (hazard ratio [HR] = 2.48, 95% CI [1.05-5.86], P = 0.038), MAP < 50 mmHg for ≥ 14 min (HR = 2.60, 95% CI [1.01-6.65], P = 0.047), MAP < 45 mmHg for ≥ 13 min (HR = 4.98, 95% CI [1.18-21.0], P = 0.029), and MAP < 40 mmHg for ≥ 5 min (HR = 6.72, 95% CI [1.56-28.9], P = 0.010), whereas longer exposure durations at MAP < 65 or < 60 mmHg were not independently associated with increased mortality. Furthermore, both a lower MAP and longer exposure duration for each threshold increased the predicted probability of 1-year mortality.

Moderate-to-severe hypotension was independently associated with increased 1-year mortality after LT. These findings underscore the importance of intraoperative blood pressure management in LT recipients.