What question did this study set out to answer?

To investigate the relationship between intraoperative hypotension and long-term mortality in liver transplantation recipients.

April 25, 2026Open Access

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

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: End-stage liver disease undergoing liver transplantation (n=1063). Intervention: Intraoperative hypotension vs. Shorter duration or absence of severe hypotension. Primary outcome: All-cause mortality within 1 year of liver transplantation (HR 6.72, 95% CI 1.56-28.9, p=0.010).

Key Result

Moderate-to-severe intraoperative hypotension, such as mean arterial pressure < 40 mmHg for ≥ 5 minutes, was independently associated with increased 1-year mortality (HR 6.72) after liver transplantation.

Key Points

To investigate the relationship between intraoperative hypotension and long-term mortality in liver transplantation recipients.
Analyzed the association of moderate-to-severe hypotension during liver transplantation with subsequent mortality outcomes.
Monitored blood pressure levels during the intraoperative phase of liver transplantation.
Moderate-to-severe hypotension was associated with increased 1-year mortality after liver transplantation (LT), with hazard ratios indicating a significant risk.
Findings highlight the critical need for better intraoperative blood pressure management in LT recipients.

Study Design

Type

Cohort (n=1,063)

Multicenter

Structured PICO

Does intraoperative hypotension increase 1-year mortality in adult patients undergoing liver transplantation?

Population

1,063 adult patients aged ≥ 18 years who underwent liver transplantation (LT), including both living and deceased donor transplantations, at the University of Pittsburgh Medical Center between January 2012 and June 2023. Excluded: intraoperative death, simultaneous transplantation, or chronic kidney disease requiring hemodialysis.

Intervention

Intraoperative hypotension (IOH) defined by various mean arterial pressure (MAP) thresholds (< 65, < 60, < 55, < 50, < 45, and < 40 mmHg) and cumulative exposure durations.

Comparator

Patients without intraoperative hypotension or with shorter exposure durations at the specified MAP thresholds.

Outcome

All-cause mortality within 1 year of liver transplantation.hard clinical

Moderate-to-severe intraoperative hypotension during liver transplantation is independently associated with increased 1-year all-cause mortality, highlighting the importance of intraoperative blood pressure management.

Main Result

Effect estimate: HR 6.72 (95% CI 1.56-28.9)

p-value: p=0.010

Limitations

Retrospective observational study design
Detailed donor characteristics were not consistently available in the institutional database
Patients with missing intraoperative MAP data were excluded without imputation
Single-center study

Abstract

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.

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Cite This Study

Katayama et al. (Thu,) conducted a cohort in End-stage liver disease undergoing liver transplantation (n=1,063). Intraoperative hypotension vs. Shorter duration or absence of severe hypotension was evaluated on All-cause mortality within 1 year of liver transplantation (HR 6.72, 95% CI 1.56-28.9, p=0.010). Moderate-to-severe intraoperative hypotension, such as mean arterial pressure < 40 mmHg for ≥ 5 minutes, was independently associated with increased 1-year mortality (HR 6.72) after liver transplantation.

synapsesocial.com/papers/69ec5b6088ba6daa22dacea2 https://doi.org/https://doi.org/10.4097/kja.25965

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