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

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.

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.

Connected Papers

Building similarity graph...

Analyzing shared references across papers

Discussion

Authors

Akira Katayama

Ezeldeen Abuelkasem

Leon Su

Journals

Korean journal of anesthesiology

Actions

Institutions

University of Pittsburgh

Okayama University

References and Citations

Connected Papers

Building similarity graph...

Analyzing shared references across papers

Discussion

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.

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

Also consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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

Key Result

Key Points

Study Design

Structured PICO

Limitations

Abstract

Citation Network

Connected Papers

Discussion

Authors

Journals

Actions

Institutions

References and Citations

Citation Network

Connected Papers

Discussion

Cite this study

Also consider