Background: The hypotension prediction index (HPI), derived from various features of the arterial waveform, was recently introduced and clinically validated in various surgical conditions.

Objective: To evaluate the performance of HPI in living donor liver transplantation recipients.

Design: Prospective observational study.

Setting: Tertiary hospital, Republic of Korea, from August 2021 to January 2022.

Patients: Twenty adult patients undergoing living donor liver transplantation were enrolled.

Intervention: HPI was monitored via a radial artery catheter during liver transplantation.

Main outcome measures: The mean arterial pressure and HPI were recorded from the end of anaesthetic induction until the end of surgery at 1-minute intervals. The area under the curve (AUC) of the receiver operating characteristic curve was calculated to show the performance of HPI at 5, 10, and 15 min for the whole dataset and in each phase of liver transplantation.

Results: The AUCs for predicting hypotension in the consecutive 5, 10, and 15 min were 0.810 (95% confidence interval [CI]: 0.802–0.818), 0.726 (95% CI: 0.716–0.735) and 0.689 (95% CI: 0.679–0.699), respectively.

In the preanhepatic phase, the AUCs in the 5-, 10-, 15-min windows were 0.795 (95% CI: 0.780–0.810), 0.694 (95% CI: 0.677–0.711), and 0.626 (95% CI: 0.608–0.645), respectively. In the anhepatic phase, the AUCs in the 5-, 10-, 15-min windows were 0.728 (95% CI: 0.706–0.749), 0.672 (95% CI: 0.649–0.694), and 0.683 (95% CI: 0.660–0.705), respectively. In the neohepatic phase, the AUCs in the 5-, 10-, 15-min windows were 0.837 (95% CI: 0.826–0.848), 0.740 (95% CI: 0.727–0.753), and 0.691 (95% CI: 0.677–0.704), respectively.

Conclusions: HPI can be used as an aid in the hemodynamic management of patients undergoing liver transplantation. Predictability was the highest in the neohepatic phase and the lowest in the anhepatic phase.