Prior esophageal variceal bleeding does not adversely affect survival after orthotopic liver transplantation

Abstract

Prior variceal bleeding may adversely affect the prognosis of orthotopic liver transplantation. We studied this question by evaluating all 175 adult patients undergoing orthotopic liver transplantation at our institution to determine risk factors associated with mortality after transplantation. Seventy patients demonstrated prior variceal bleeding, and of those, 32 had a course of sclerotherapy. Thirteen also had portal systemic shunts. Compared with the 105 transplant patients who had no prior bleeding, patients who bled were more likely to have parenchymal liver disease (74% vs. 50%), equally likely to have cholestatic liver disease (19%), and less likely to have malignancy (6% vs. 19%) or fulminant liver failure (1% vs. 12%). Bleeding patients also were more likely to be Child-Pugh class C (46% vs. 35%). By the common closing date of December 31, 1990, 26 patients (37%) with prior bleeding and 48 patients (46%) without bleeding died after transplantation. From survival curves, patients with prior bleeding had improved survival rates at 1 yr (65% vs. 54%), at 3 yr (60% vs. 47%) and at 5 yr (55% vs. 43%), although the differences were not statistically significant. With a proportional hazards model to adjust for confounding effects, the relative risk of mortality among patients with prior bleeding was 0.60 (95% confidence interval, 0.27 to 1.30). Sclerotherapy or portal systemic shunts did not alter survival. Important adverse risk factors for mortality included older age at transplantation, black race, malignant disease and more advanced Child-Pugh class. This study suggests that prior esophageal variceal bleeding did not adversely affect the mortality of patients undergoing orthotopic liver transplantation.

Liver Transplantation in a Randomized Controlled Trial of Emergency Treatment of Acutely Bleeding Esophageal Varices in Cirrhosis

“…However, the survival rate of the 19 unrandomized patients who underwent LT was 89% after 30 days and 53% after 5 years, which was not significantly different from the survival rates for LT reported by UNOS. PCS did not increase the mortality rate or complications of subsequent LT. Added to the data from our study-are at least 10 reports of retrospective studies in the literature that concluded that portosystemic shunts do not affect the results of subsequent LT [11–13, 29–36]. That conclusion has not been contradicted by reported studies.…”

Liver Transplantation in a Randomized Controlled Trial of Emergency Treatment of Acutely Bleeding Esophageal Varices in Cirrhosis

“…However, the survival rate of the 19 unrandomized patients who underwent LT was 89% after 30 days and 53% after 5 years, which was not significantly different from the survival rates for LT reported by UNOS. PCS did not increase the mortality rate or complications of subsequent LT. Added to the data from our study-are at least 10 reports of retrospective studies in the literature that concluded that portosystemic shunts do not affect the results of subsequent LT [11][12][13][29][30][31][32][33][34][35][36]. That conclusion has not been contradicted by reported studies.…”

Comparação entre as pressões portal e da veia hepática ocluída no transplante de fígado

“…O Tx é considerado um tratamento definitivo para a hipertensão portal em pacientes cirróticos já que, teoricamente, corrige tanto a alteração hemodinâmica quanto a doença hepática crônica de base 8 Entretanto, alguns trabalhos têm relatado a ocorrência de complicações da hipertensão portal, como sangramento de varizes de esôfago 12 e ascite 910 mesmo após o Tx. Estas complicações podem estar relacionadas com a persistência de alterações da hemodinâmica portal após o procedimento.…”