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

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, 0.0.91-0.98), 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.