Liver Transplantation as Ultimate Tool to Treat Portal Hypertension

Abstract

Portal hypertension is a complication of liver cirrhosis that may itself cause complications such as variceal bleeding, ascites and hepatorenal syndrome. There are several options for symptomatic treatment including drug therapy, endoscopy, transjugular intrahepatic portosystemic shunt (TIPS), and various surgical procedures, notably liver transplantation, the only causal treatment. The indication for liver transplantation has to be defined carefully. Progression of the primary disease, evaluation of comorbidity and overall prognosis have to be considered. Conservative symptomatic treatment is used for bridging purposes until liver transplantation can be provided to cure portal hypertension and the underlying primary disease. Careful timing of the transplantation is necessary as well as reorganization of the waiting lists by introducing new priority systems as the Model for End-Stage Liver Disease (MELD) in order to reduce mortality. Furthermore, living donor liver transplantation and split liver transplantation are methods to enlarge the donor pool, and thus accessibility of transplantation to a greater number of patients. This review evaluates the indication of liver transplantation in the treatment of portal hypertension.

An assessment of surgery for portal hypertensive patients performed at a single community hospital

“…Furthermore, the widespread access to liver transplantation provides defi nitive treatment of varices by eliminating portal hypertension altogether. 9 Due to the technical diffi culties associated with this surgical modality, the performance of surgery for portal hypertensive patients has been limited to academic institutions and specialized clinical centers. However, as the total number of patients who require surgery decreases, this limitation has been relaxed.…”

Improved prognosis for patients hospitalized with esophageal varices in Sweden 1969–2002

“…[1][2][3][4][5] Sclerosing of esophageal varices became common in Sweden in the mid-1980s, and liver transplantation has been performed in Sweden since 1984. 6 Prophylactic antibiotics, somatostatin, and terlipressin have been in use since the beginning of the 1990s.…”

Hepatorenales Syndrom

“…Durch eine Le ber trans plan ta ti on kann so wohl die Le ber-als auch die Nie ren in suf fi zi enz im Rah men des HRS kau sal be han delt wer den [26]. Für Pa ti en ten mit ei nem HRS Typ 1 ist die Progno se in fol ge des ra schen Fort schrei tens der Er kran kung un ab hän gig vom MELD-Sco re, für Pa ti en ten mit HRS Typ 2 kor re liert ein ho her MELD-Sco re mit ei ner un güns ti gen Prog no se [2].…”