Blood Pressure Variability Early After Liver Transplant Predicts Long-Term Mortality.

Cardiovascular disease is a leading cause of mortality after liver transplant (LT). Elevated blood pressure (BP) in liver transplant 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 2010-2016. Day-to-day BP variability within the first 60 days after LT was measured utilizing 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% female, 10.7% black, mean age 56.5 years), increased systolic BP variability was associated with a decreased risk of mortality (adjusted Hazard Ratio (aHR) 0.966/1 unit VIM, 95% confidence interval (CI) 0.938-0.995). This was particularly true for males (aHR 0.941, CI 0.907-0.977), patients with pre-LT atherosclerotic cardiovascular disease (aHR 0.951, CI 0.917-0.985), and patients without pre-LT diabetes (aHR 0.962, CI 0.927-0.998). 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 (HR 0.958, CI 0.903-1.016) nor mortality (HR 1.001, CI 0.947-1.057). Increased systolic BP variability, independent of mean BP, is associated with decreased mortality in LTRs. We postulate that increased BP variability reflects a better vascular recovery in persons undergoing LT, but further research is needed as to the mechanism underlying our observation.