Portal Hypertension after Liver Transplantation—Causes and Management

Unger, Lukas; Mandorfer, Mattias; Reiberger, T

doi:10.1007/s11901-019-00450-8

Cited by 5 publications

(2 citation statements)

References 71 publications

(53 reference statements)

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“…This series indicates that, even in technically challenging cases, excellent results are achievable in highly specialised centres. Since end-toend anastomosis was feasible in 96% of patients who underwent liver transplantation in the latter series, this report also suggests that pre-transplant recanalisation of the porto-splenomesenteric axis may decrease the need for surgical recanalisation or non-physiological PV reconstruction at the time of liver transplantation, 107 and thus, may even improve post-transplant outcomes.…”

Section: Tips For Pvtmentioning

confidence: 69%

Where does TIPS fit in the management of patients with cirrhosis?

García‐Pagán

Saffo²,

Mandorfer³

et al. 2020

JHEP Reports

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In this review, we summarise the current knowledge on the indications and contraindications of transjugular intrahepatic portosystemic shunt (TIPS) placement for the treatment of the complications of portal hypertension in cirrhosis, specifically variceal haemorrhage and ascites. Moreover, we discuss the role of TIPS for the treatment of portal vein thrombosis (PVT) and the prevention of complications after extrahepatic surgery ('preoperative TIPS') in patients with cirrhosis. The position of TIPS in the treatment hierarchy depends on the clinical setting and on patient characteristics. In acute variceal haemorrhage, preemptive TIPS is indicated in patients at a high risk of failing standard therapy, that is those with a Child-Pugh score of 10-13 points or Child-Pugh B with active bleeding at endoscopy, although the survival benefit in the latter group still remains to be established. Non-preemptive TIPS is a second-line therapy for the prevention of recurrent variceal haemorrhage and for the treatment of ascites. Of note, TIPS may also improve sarcopenia. Contraindications to TIPS placement, independent of clinical setting, include very advanced disease (Child-Pugh >13 points), episodes of recurrent overt hepatic encephalopathy without an identifiable precipitating factor, heart failure, and pulmonary hypertension. In patients with PVT, TIPS placement not only controls complications of portal hypertension, but also promotes portal vein recanalisation. Although the severity of portal hypertension correlates with poor outcomes after extrahepatic surgery, there is no evidence to recommend preoperative TIPS placement.

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Section: Tips For Pvtmentioning

confidence: 69%

Where does TIPS fit in the management of patients with cirrhosis?

García‐Pagán

Saffo²,

Mandorfer³

et al. 2020

JHEP Reports

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“…In terms of long-term outcomes of NASH LT recipients, survival rates are comparable to other etiologies despite the fact that Malik et al [ 127 ] found an alarming 50% 1-year mortality rate among obese NASH patients ≥ 60 years old with T2DM and arterial hypertension[ 127 ]. Thus, pre-transplant work-up warrants extensive risk-benefit evaluation on a case-to-case basis before listing for LT to avoid unexpected complications[ 128 ].…”

Section: Obesity and Mafld/nash Before And After Ltmentioning

confidence: 99%

Individualized treatment options for patients with non-cirrhotic and cirrhotic liver disease

Hartl¹,

Elias²,

Prager³

et al. 2021

WJG

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The obesity pandemic has led to a significant increase in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). While dyslipidemia, type 2 diabetes mellitus and cardiovascular diseases guide treatment in patients without signs of liver fibrosis, liver related morbidity and mortality becomes relevant for MAFLD’s progressive form, non-alcoholic steatohepatitis (NASH), and upon development of liver fibrosis. Statins should be prescribed in patients without significant fibrosis despite concomitant liver diseases but are underutilized in the real-world setting. Bariatric surgery, especially Y-Roux bypass, has been proven to be superior to conservative and/or medical treatment for weight loss and resolution of obesity-associated diseases, but comes at a low but existent risk of surgical complications, reoperations and very rarely, paradoxical progression of NASH. Once end-stage liver disease develops, obese patients benefit from liver transplantation (LT), but may be at increased risk of perioperative infectious complications. After LT, metabolic comorbidities are commonly observed, irrespective of the underlying liver disease, but MAFLD/NASH patients are at even higher risk of disease recurrence. Few studies with low patient numbers evaluated if, and when, bariatric surgery may be an option to avoid disease recurrence but more high-quality studies are needed to establish clear recommendations. In this review, we summarize the most recent literature on treatment options for MAFLD and NASH and highlight important considerations to tailor therapy to individual patient’s needs in light of their risk profile.

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Unlikely Death From Esophageal Variceal Hemorrhage in a Post-Orthotopic Liver Transplant Patient

Leatheng,

Khatskevich,

Erno

et al. 2024

Academic Forensic Pathology

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Gastrointestinal bleeding is one of the complications seen after a liver transplant with a poor prognosis and low survival. The most common cause of gastrointestinal bleeding after a liver transplant is ulcers followed by hemorrhagic enteritis and portal hypertensive lesions. We present a case of a middle-aged male, with improving liver function labs and imaging, who passed away from large-volume hematemesis approximately 2 months after a liver transplant. On autopsy, the cause of death was concluded to be from acute upper gastrointestinal hemorrhage due to esophageal variceal bleeding.

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Portal Hypertension after Liver Transplantation—Causes and Management

Cited by 5 publications

References 71 publications

Where does TIPS fit in the management of patients with cirrhosis?

Where does TIPS fit in the management of patients with cirrhosis?

Individualized treatment options for patients with non-cirrhotic and cirrhotic liver disease

Unlikely Death From Esophageal Variceal Hemorrhage in a Post-Orthotopic Liver Transplant Patient

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