Blood Pressure Variability Early After Liver Transplantation Predicts Long‐Term Mortality

Abstract

Cardiovascular disease is a leading cause of mortality after liver transplantation (LT). Elevated blood pressure (BP) in LT recipients (LTRs) is associated with increased cardiovascular events (CVEs) and decreased survival. Increased visit‐to‐visit BP variability in the general population is associated with adverse outcomes. Whether BP variability is associated with adverse outcomes in LTRs is unknown. We analyzed data from adult LTRs within a single large transplant center in the United States between 2010 and 2016. Day‐to‐day BP variability within the first 60 days after LT was measured using variability independent of the mean (VIM). To assess the association between early post‐LT BP variability and future CVEs or mortality, we used Cox proportional hazard regression. Among 512 LTRs (34.4% women; 10.7% Black; mean age, 56.5 years), increased systolic BP (SBP) variability was associated with a decreased risk of mortality (adjusted hazard ratio [aHR], 0.97/1 unit VIM; 95% confidence interval [CI], 0.94‐0.99). This was particularly true for men (aHR, 0.94; 95% CI, 0.91‐0.98), patients with pre‐LT atherosclerotic cardiovascular disease (aHR, 0.95; 95% CI, 0.92‐0.98), and patients without pre‐LT diabetes mellitus (aHR, 0.96; 95% CI, 0.93‐1.00). There was no significant effect of BP variability on CVEs. Results were consistent when competing risk analysis was used with death as the competing risk. Increased diastolic BP variability was not associated with a significant effect on CVEs (hazard ratio [HR], 0.96; 95% CI, 0.90‐1.02) nor mortality (HR, 1.00; 95% CI, 0.95‐1.06). Increased SBP variability, independent of mean BP, is associated with decreased mortality in LTRs. We postulate that increased BP variability reflects a better vascular recovery in patients undergoing LT, but further research is needed as to the mechanism underlying our observation.

Impact of Pretransplant Diabetes on Outcomes After Liver Transplantation: An Updated Meta-analysis With Systematic Review

“…A total of 42 studies conducted between 1982 and 2019 were included in this meta-analysis (Figure 1). The included studies were conducted in various countries including 1 in Canada, 5 France, 31 India, 32 Iran, 33 Italy, 34 Poland, 35 Singapore, 36 South Korea, 37 and Taiwan; 38 2 in Brazil; 39,40 3 in China; [41][42][43] 4 in Japan, [44][45][46][47] Spain, 6,[48][49][50] and the United Kingdom; [51][52][53][54] and 15 in the United States of America [55][56][57][58][59][60][61][62][63][64][65][66][67][68][69] , respectively. Only one study was a multinational study 70 recipient.…”

Blood Pressure Variability in Liver Transplant Recipients: The Who, What, When, and How

“…Indeed, excluded individuals experienced cardiovascular events at twice the rate of the study cohort (17.8% versus 8.4%). ( 2 ) How the posttransplant clinical course impacts the consistency and reliability of blood pressure measurements warrants more clarity. There may also be a role for leveraging remote patient monitoring to improve the consistency of blood pressure measurements during this clinically complex period.…”

“…In this issue of Liver Transplantation , Truitt et al investigate the potential of blood pressure variability measurements to serve as a prognosticator for cardiovascular morbidity and overall mortality. ( 2 )…”

Risk factors for fractures following liver transplantation: a population-based cohort study

“…The adjusted hazard ratios (95% confidence intervals) for incident any fracture was 1.07 (1.06–1.08) for the higher quartile of systolic BPV, 1.06 (1.05–1.07) for diastolic BPV, and 1.07 (1.06–1.08) for both systolic and diastolic BPV. This is particularly important as early BPV has also been identified as a potential prognostic factor for predicting overall mortality in liver transplant recipients [ 3 , 4 ].…”