Intraoperative Hypotension Increases 1-Year Mortality After Liver Transplantation: Study
Researchers have found in a new study that moderate-to-severe hypotension during liver transplantation is independently linked to higher 1-year mortality, highlighting the critical role of maintaining stable intraoperative blood pressure in improving patient outcomes.
Intraoperative hypotension (IOH) is common during liver transplantation (LT); however, its impact on long-term mortality remains unclear. We investigated the association between Intraoperative hypotension and 1-year mortality using various mean arterial pressure (MAP) thresholds and exposure durations.
This retrospective observational cohort study included 1063 patients who underwent liver transplantation. They defined Intraoperative hypotension as an MAP < 65 mmHg and examined each threshold in 5 mmHg increments to < 40 mmHg.The primary outcome was 1-year mortality after liver transplantation. Multivariate logistic regression was used to control for confounding variables while assessing the association between Intraoperative hypotension 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 liver transplantation. These findings underscore the importance of intraoperative blood pressure management in liver transplantation recipients.
Reference:
Katayama, A., Abuelkasem, E., Su, L. C., & Wang, D. W. (2026). Intraoperative hypotension during liver transplantation is associated with long-term mortality. Korean Journal of Anesthesiology. Advance online publication. https://doi.org/10.4097/kja.25965
KeywordS:
Intraoperative, Hypotension, Increases 1-Year, Mortality, After, Liver, Transplantation, Study, Hemodynamics; Hypotension; Intraoperative period; Lactic acid; Liver transplantation; Mortality, Katayama, A., Abuelkasem, E., Su, L. C., & Wang, D. W.
