Session Date & Time: None. Available on demand.
*Purpose: Cardiovascular disease is a leading cause of mortality in liver transplant recipients (LTRs). Adequate blood pressure (BP) control within one year after liver transplant (LT) is associated with improved survival and decreased cardiovascular events (CVEs). However, in clinical practice, extreme values of BP are often discarded, and the lowest or mean value is chosen as the “true” BP. In older adults and among perioperative cardiac surgery patients, this BP variability, independent of mean BP, is associated with adverse outcomes. Whether BP variability is associated with CVEs in LTRs is unknown.
*Methods: We conducted a longitudinal cohort study of adult LTRs within a large tertiary care network 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, we used Cox proportional hazard regression. Models were adjusted for mean BP, age, sex, race, time-varying BP medication use, and pre-transplant diabetes and atherosclerotic cardiovascular disease (ASCVD).
*Results: Among 195 LTRs (32.3% female, 10.8% black, mean age 55.6 years), 19.0% had a CVE within a mean follow up of 3.01 years (standard deviation (SD) 2.08). The average range in systolic BP was 20.89 mmHg (SD 13.60) and diastolic BP was 12.65 mmHg (SD 6.55). Increased systolic BP variability was associated with a decreased risk of CVEs (Hazard Ratio (HR) 0.95, 95% confidence interval (CI) 0.92-0.99). This was particularly true for males (HR 0.95, CI 0.90-0.99) and patients with pre-LT ASCVD (HR 0.94, CI 0.88-0.98). There was a trend towards decreased mortality among male LTRs (HR 0.95, CI 0.09-1.01), but not females. Increased diastolic BP variability was also associated with a decreased risk of CVEs (HR 0.86, 0.78-0.95); specifically for persons younger than 65 (HR 0.87, CI 0.79-0.97), males (HR 0.85, CI 0.76-0.94), and persons without pre-LT diabetes (HR 0.90, CI 0.80-1.00) or ASCVD (HR 0.77, CI 0.65-0.91).
*Conclusions: Increased BP variability, independent of mean BP, is associated with decreased CVEs in LTRs, while it is associated with adverse outcomes in other populations. We postulate that increased BP variability reflects a better vascular recovery in persons undergoing LT, but further research is needed.
To cite this abstract in AMA style:Truitt KN, Chen K, Yano Y, Gregory D, VanWagner LB. Blood Pressure Variability Immediately After Liver Transplant Predicts the Likelihood of Long-Term Cardiovascular Events [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/blood-pressure-variability-immediately-after-liver-transplant-predicts-the-likelihood-of-long-term-cardiovascular-events/. Accessed June 16, 2021.
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