Document Detail


Liver transplantation for uncontrollable variceal bleeding.
MedLine Citation:
PMID:  7942675     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: A small number of liver transplant candidates experience variceal bleeding that cannot be controlled by standard medical therapy. The objective of this study was to analyze the role of urgent liver transplantation for this subset of patients with acute, refractory, portal hypertensive bleeding. METHODS: Retrospective review of data from 416 patients undergoing 449 liver transplantations between March, 1988 and February, 1993 revealed seven patients (1.7%) with endstage liver disease who underwent transplantation for uncontrollable variceal bleeding. All patients failed therapy with intravenous pitressin, endoscopic sclerotherapy, balloon tamponade, and/or transjugular intrahepatic portosystemic shunt and continued to bleed. Patients ranged in age from 6 months to 56 years. All patients were Child's class C. Two patients were listed for transplantation with the United Network for Organ Sharing as status 3, and five patients were listed as status 4. RESULTS: All patients underwent successful liver transplantation with immediate control of bleeding. One patient expired on the 26th postoperative day from multiple organ failure, and another patient expired with recurrent hepatocellular carcinoma on the 110th postoperative day. No patients experienced late rebleeding from varices after transplantation. CONCLUSIONS: Urgent liver transplantation is effective and feasible for the small subset of patients with uncontrollable variceal bleeding and endstage liver disease. Prompt and complete evaluation of the potential recipient and availability of a donor organ are critical to the success of this approach.
Authors:
H Ewaga; E B Keeffe; J Dort; W Concepcion; C O Esquivel
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  89     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  1994 Oct 
Date Detail:
Created Date:  1994-10-31     Completed Date:  1994-10-31     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1823-6     Citation Subset:  IM    
Affiliation:
Department of Transplantation, California Pacific Medical Center, San Francisco.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adolescent
Adult
Child
Child, Preschool
Emergencies
Esophageal and Gastric Varices / etiology,  therapy*
Female
Humans
Hypertension, Portal / complications
Infant
Liver Transplantation*
Male
Middle Aged
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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