Non-selective beta blocker use is associated with improved short-term survival in patients with cirrhosis referred for liver transplantation

Abstract

Background: Recent evidence cautions against the use of non-selective beta-blockers (NSBB) in patients with refractory ascites or spontaneous bacterial peritonitis while other data suggests a survival benefit in patients with advanced liver disease. The aim of this study was to describe the use and impact of NSBB in patients with cirrhosis referred for liver transplantation. Methods: A single-center cohort of patients with cirrhosis, who were referred and evaluated for liver transplantation between January and June 2012 were studied for baseline characteristics and clinical outcomes. Patients were grouped according to the use of NSBB at initial evaluation, with the endpoint of 90-day mortality. Results: Sixty-five (38%) of 170 consecutive patients evaluated for liver transplantation were taking NSBB. Patients taking NSBB had higher MELD and Child Pugh score. NSBB use was associated with lower 90-day mortality (6% vs. 15%) with a risk adjusted hazard ratio of 0.27 (95%CI .09-0.88, p = .03). Patients taking NSBB developed acute kidney injury (AKI) within 90 days more frequently than patients not taking NSBB (22% vs 11%), p = 0.048). However, this was related to increased stage 1 AKI episodes, all of which resolved. Twelve (27%) of 45 patients with > 90 day follow up discontinued NSBB, most commonly for hypotension and AKI, had increased subsequent MELD and mortality. Conclusions: NSBB use in patients with cirrhosis undergoing liver transplant evaluation is associated with better short-term survival. Nevertheless, ongoing tolerance of NSBB in this population is dynamic and may select a subset of patients with better hemodynamic reserve.

Non-Selective Beta-Blockers Decrease Infection, Acute Kidney Injury Episodes, and Ameliorate Sarcopenic Changes in Patients with Cirrhosis: A Propensity-Score Matching Tertiary-Center Cohort Study

“…Several studies have also reported lower rates of infection and alleviation of infection-related morbidity and mortality, as well as the reduction of likelihood of hospitalization for infection in cirrhotic patients, which was compatible with our findings [ 38 , 39 ]. In SBP, the infection directly related to intestinal bacterial translocation, albeit the data were debatable; previous studies and meta-analyses have indicated that NSBBs can prevent its occurrence and improve short-term survival in cirrhotic patients [ 12 , 40 ]. In the present work, an insignificant difference in SBP occurrence was observed between two groups, possibly due to relatively low incidence in the enrolled participants, although the proportions of SBP were approximate to those in previous study [ 39 ].…”

“…NSBB-responders have fewer events of SBP and HE [ 8 ]. Furthermore, NSBBs reduce the incidence of hepatocellular carcinoma (HCC) in patients with cirrhosis because of various etiologies, and improve survival in cirrhotic patients with ascites or referral for liver transplantation [ 9 , 10 , 11 , 12 ].…”

β-blockers in advanced cirrhosis: More friend than enemy

“…Ngwa and colleagues [ 56 ] recently reported on a cohort of 170 consecutive patients referred to their center for liver transplant evaluation. Among them, 38 patients were taking β-blockers.…”

Post–Liver Transplant Acute Kidney Injury

“…(61) Nonselective β-blockers often used for primary or secondary prevention of variceal hemorrhage should be stopped when AKI is present because of possible ischemic effects on the kidneys. (62) Special consideration needs to be given to HRS. Overall, it represents a functional form of AKI in patients with cirrhosis.…”