Options for elective treatment of portal hypertension in cirrhotic patients in the transplantation era

A 27-Year Experience With Surgical Treatment of Budd-Chiari Syndrome

“…Also, at least eight recent studies have shown that a previous portasystemic shunt, regardless of type, had no influence on the outcome of OLT. [41][42][43][44][45][46][47][48] Aboujaoude et al 48 emphasized that thrombosis of a portasystemic shunt may seriously compromise performance of OLT, so that longterm shunt patency should be the main factor that determines the type of shunt selected for the potential OLT candidate, a point that is especially important in patients with BCS. Direct portacaval shunt had a thrombosis rate of 0.2% or less in all of our studies, compared with occlusion rates of 24% to 53% for mesocaval interposition shunts using synthetic grafts reported in the literature.…”

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.…”

“…Some transplant centers have considered BEV in cirrhosis to be an indication for LT. It has been proposed that LT be considered the treatment of choice for "patients with advanced liver disease after failure of sclerotherapy" [11,12] and for "all patients with end-stage liver disease (group C) and variceal bleeding… in the absence of any contraindications" [11][12][13]. Regrettably, there have been no randomized controlled trials of LT following any of the emergency modalities of therapy for BEV to support or contradict these proposals.…”

Portale Hypertension – Bedeutung für den Transplantationszeitpunkt

“…Im Child-Stadium B mit progredientem Leberversagen oder ohne Leberreserve sowie beim Child-C-Patienten ist die Trans plantation das Verfahren der Wahl [6,7,9,12,13,15,[23][24][25], Voraussetzung ist das Fehlen von Kontraindikationen. Sind Kon traindikationen vorhanden, so ist eine Dauersklerosierung und medikamentöse Drucksenkung im Pfortadergebiet zu empfehlen [5], Kommt es hierunter zu weiterer Blutung, so ist eine Shunt operation möglich, jedoch mit einem erhöhten Risiko [7, 10.…”