Intraoperative exposure to a mean arterial pressure <55 mm Hg for 25 minutes or longer was significantly associated with increased 30-day mortality after liver transplantation (OR 1.772).
Cohort (n=1,178)
No
Is intraoperative hypotension associated with increased 30-day mortality in adult patients undergoing liver transplantation?
In adult liver transplantation, intraoperative MAP <55 mm Hg for ≥25 minutes is associated with increased 30-day mortality, whereas exposure to MAP <60 mm Hg for up to 120 minutes is not.
Odds Ratio: 1.772 (95% CI 1.008–3.114)
p-value: p=0.047
Background. Intraoperative hypotension (IOH) is common and associated with mortality in major surgery. Although patients undergoing liver transplantation (LT) have low baseline blood pressure, the relation between blood pressure and mortality in LT is not well studied. We aimed to determine mean arterial pressure (MAP) that was associated with 30-d mortality in LT. Methods. We performed a retrospective cohort study. The data included patient demographics, pertinent preoperative and intraoperative variables, and MAP using various metrics and thresholds. The endpoint was 30-d mortality after LT. Results. One thousand one hundred seventy-eight patients from 2013 to 2020 were included. A majority of patients were exposed to IOH and many for a long period. Eighty-nine patients (7.6%) died within 30 d after LT. The unadjusted analysis showed that predicted mortality was associated with MAP <45 to 60 mm Hg but not MAP <65 mm Hg. The association between MAP and mortality was further tested using adjustment and various duration cutoffs. After adjustment, the shortest durations for MAPs <45, 50, and 55 mm Hg associated with 30-d mortality were 6, 10, and 25 min (odds ratio, 1.911, 1.812, and 1.772; 95% confidence interval, 1.100-3.320, 1.039-3.158, and 1.008-3.114; P = 0.002, 0.036, and 0.047), respectively. Exposure to MAP <60 mm Hg up to 120 min was not associated with increased mortality. Conclusion. In this large retrospective study, we found IOH was common during LT. Intraoperative MAP <55 mm Hg was associated with increased 30-d mortality after LT, and the duration associated with postoperative mortality was shorter with lower MAP than with higher MAP.
Wang et al. (Thu,) conducted a cohort in Liver transplantation (n=1,178). Intraoperative hypotension (MAP <55 mm Hg for ≥25 min) vs. MAP ≥55 mm Hg or duration <25 min was evaluated on 30-day all-cause mortality (OR 1.772, 95% CI 1.008-3.114, p=0.047). Intraoperative exposure to a mean arterial pressure <55 mm Hg for 25 minutes or longer was significantly associated with increased 30-day mortality after liver transplantation (OR 1.772).