[Liver transplantation in the treatment strategy of portal hypertension]

Abstract

We reviewed 1000 consecutive liver transplants over a 10 year period with special attention to a pre-transplant history of portal hypertension revealed by variceal hemorrhage. Of 730 primary transplanted patients with chronic liver disease 186 (26%) experienced variceal bleeding prior to transplantation of which 130 (70%) required interventional therapy to palliate the bleeding. Sclerotherapy was performed in 93 (50%), surgical portal diversion in 27 (15%) and TIPSS in 10 (5%) patients. Moderate to severe liver dysfunction accounted for 91% of the patients with bleeding complications. The impact of both bleeding and treatment modality utilized in the pre-transplant period was analyzed in a way to integrate liver transplantation into the multimodality treatment of portal hypertension. The overall survival for all patients was 76% at five years. Previous history of variceal bleeding did not affect the outcome of patients following liver transplantation. The patients treated by initial sclerotherapy demonstrated no difference with either graft or patient survival. The patients who had TIPSS to control hemorrhage had lower, but insignificant, graft and patient survival. The group of patients with variceal hemorrhage who had prior surgical shunt did, however, demonstrate a significant increased survival of 96% when compared to the non-shunted group which had a 73% survival (p < 0.007). The strategy in treating these potential transplant patients is critical to the success of the subsequent transplant.