Association of Mean Arterial Pressure (MAP) with Mortality in Patients with Liver Cirrhosis Awaiting Transplantation

Document Type

Conference Proceeding

Publication Date

8-2-2025

Publication Title

Am J Transplant

Abstract

Purpose: Patients with liver cirrhosis listed for liver transplantation often experience hemodynamic changes, including changes in mean arterial pressure (MAP). Identifying the prognostic impact of MAP on mortality in this population may guide clinical decision-making. This study evaluates the association between MAP and mortality in patients listed for liver transplant. Methods: We conducted a retrospective cohort study of adult patients with liver cirrhosis listed for liver transplantation at a quaternary care center. To ensure comparability, only patients with a Model for End-Stage Liver Disease (MELD) score of 20-24 at the time of listing were included, while those with hepatocellular carcinoma (HCC) were excluded. Data collected included demographic information, mean arterial pressure (MAP) at listing, and clinical factors such as the use of antihypertensive medications, beta-blockers, and midodrine, as well as complications like hepatorenal syndrome (HRS), hepatic encephalopathy (HE), ascites, and variceal bleeding. We used logistic regression models to analyze the relationship between MAP and mortality on the waiting list, adjusting for medications and complications to isolate the independent effect of MAP. Additionally, a two-sample t-test was performed to compare the mean MAP between patients who died and those who survived Results: A total of 103 patients were analyzed. Higher MAP was significantly associated with lower odds of mortality on the waiting list (OR = 0.94, 95% CI: 0.89-0.99, p = 0.041). Each unit increase in MAP was associated with a 6% reduction in mortality risk. The mean MAP was significantly lower in patients who died (76.9 mmHg) compared to those who survived (83.2 mmHg) (p = 0.043). Additionally, higher MAP was associated with a decreased risk of HRS (OR = 0.94, 95% CI: 0.89-0.98, p = 0.011), but no significant associations were found between MAP and HE (OR = 0.97, 95% CI: 0.93-1.02, p = 0.247), ascites (OR = 1.00, 95% CI: 0.95-1.05, p = 0.847), or variceal bleeding (OR = 1.02, 95% CI: 0.95-1.09, p = 0.567). Conclusions: Lower MAP at the time of listing is an independent predictor of mortality in cirrhotic patients awaiting liver transplantation. The association remains robust after controlling for disease severity (MELD score), medications, and common complications. Additionally, low MAP was associated with a higher risk of developing HRS but not with HE, ascites, or variceal bleeding. These findings highlight the potential importance of hemodynamic optimization in this population. CITATION INFORMATION: Alomari A., Saleem A., Althunibat I., Abusuliman M., Dababneh Y., Jomaa D., Abdulraheem A., Mo J., Chen K., Jafri S. Association of Mean Arterial Pressure (MAP) with Mortality in Patients with Liver Cirrhosis Awaiting Transplantation AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES:

Volume

25

Issue

8

First Page

S477

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