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

Background/Objectives: In cirrhotic patients, guidelines generally recommend maintaining mean arterial pressure (MAP) ≥ 65 mmHg, but the prognostic impact of MAP in transplant candidates is unclear. This study aimed to evaluate the association between MAP and waitlist mortality and cirrhosis-related complications in patients listed for liver transplantation. Methods: We conducted a retrospective cohort study of 103 adults (age ≥ 18 years) with cirrhosis listed for liver transplantation (MELD 20–24) at a single center (2019–2023). Patients with hepatocellular carcinoma were excluded. The primary outcome was death on the transplant waitlist (n = 9 events). Logistic regression was used to assess the association of MAP (per 1 mmHg) with mortality. Continuous variables were compared using the t-test, and categorical variables were compared using the chi-square test; p < 0.05 was considered significant. Results: Mean MAP at listing was significantly higher in survivors than non-survivors (83.2 ± 9.4 vs. 76.9 ± 8.7 mmHg; p = 0.04). In logistic regression, higher MAP was associated with lower odds of waitlist death (unadjusted odds ratio [OR] per 1 mmHg increase = 0.94; 95% confidence interval [CI] 0.89–0.99; p = 0.041). Subgroup analysis showed a significant inverse association between MAP and hepatorenal syndrome (HRS) (OR per 1 mmHg = 0.94; 95% CI 0.89–0.98; p = 0.011), whereas MAP was not significantly associated with hepatic encephalopathy, ascites, or variceal bleeding (all p > 0.2). Conclusions: Among the cirrhotic patients listed for transplantation, lower MAP at baseline is associated with waitlist mortality and hepatorenal syndrome. These findings should be interpreted cautiously given the small number of events and require validation in larger cohorts.