Analysis on Effect of Liver Transplantation in Treatment of Upper Gastrointestinal Hemorrhage in Patients with Portal Hypertension_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YU Jun , ZHANG Wu , ZHANG Min , WANG Weilin , ZHOU Lin , SHEN Yan , TANG Saxiao , CHEN Longyu , XIE Shangfen , CHEN Zhiyun ,  ZHENG Shusen.

Department of Hepatobiliary and Pancreatic Surgery， First Affiliated Hospital， School of Medicine， Zhejiang University， Hangzhou 310003， Zhejiang Province， China;

Corresponding author：

ZHENG Shusen., Email: shusenzheng@zju.edu.cn

Keywords：

Liver transplantation; Portal hypertension; Upper gastrointestinal hemorrhage

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To explore the feasibility and safety of liver transplantation （LT） in treatment of upper gastrointestinal hemorrhage in patients with portal hypertension， and to compare the therapeutic effects with conventional operation （CO）.
Methods 　The clinical data of 303 patients with bleeding portal hypertension from Feb. 2009 to Feb. 2012 in the department of hepatobiliary and pancreatic surgery of First Affiliated Hospital of Zhejiang University were retrospectively analyzed. One hundred and one patients received LT procedure （LT group）， whereas the other 202 patients received CO procedure （CO group）. Postoperative follow-up period was 8-44 months （average 26 months）.
Results 　Liver function before operation in CO group was significantly better than that in LT group（P＜0.01）. The mortality of CO group and LT group were 7.4%（14/189） and 3.0%（3/101， P=1.00）， respectively. The rebleeding rate of patients underwent LT was 2.0%（2/101）， significantly lower than that of CO group 〔9.5%（18/189）， P＜0.05〕. The vanish rate of esophagogastric varice in patients underwent LT was 86.1%（87/101）， significantly lower than that of CO group 〔54.5%（86/189）， P＜0.01〕.
Conclusions 　LT treatment for bleeding portal hypertension is feasible and safe. Patients with good liver function despite hemorrhage history may be managed satisfactorily with conventional surgery. LT is the only curative treatment for patients with portal hypertension in end-stage liver disease.

Citation： YU Jun,ZHANG Wu,ZHANG Min,WANG Weilin,ZHOU Lin,SHEN Yan,TANG Saxiao,CHEN Longyu,XIE Shangfen,CHEN Zhiyun,ZHENG Shusen.. Analysis on Effect of Liver Transplantation in Treatment of Upper Gastrointestinal Hemorrhage in Patients with Portal Hypertension. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(1): 24-28. doi: Copy

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1. Dong MH， Saab S. Complications of cirrhosis[J]. Dis Mon， 2008， 54(7)： 445-456.
2. Gines P， Cardenas A， Arroyo V， et al. Management of cirrhosis and ascites[J]. N Engl J Med， 2004， 35(916)： 1646-1654.
3. Bari K， Garcia-Tsao G. Treatment of portal hypertension[J]. World J Gastroenterol， 2012， 18(11)： 1166-1175.
4. Dzeletovic I， Baron TH. History of portal hypertension and endoscopic treatment of esophageal varices[J]. Gastrointest Endosc， 2012， 75(6)： 1244-1249.
5. de Franchis R， Primignani M. Natural history of portal hypertensionin patients with cirrhosis[J]. Clin Liver Dis， 2001， 5(3)：645-663.
6. Garcia-Tsao G， Bosch J. Management of varices and variceal hemorrhage in cirrhosis[J]. N Engl J Med， 2010， 362(9)： 823-832.
7. Funakoshi N， Duny Y， Valats JC， et al. Meta-analysis：beta-blockers versus banding ligation for primary prophylaxis ofesophageal variceal bleeding[J]. Ann Hepatol， 2012， 11(3)： 369-383.
8. Zippi M， Traversa G， Pica R， et al. Hematemesis from esophagealvarices associated with esophageal perforation：sclerotherapy and endoscopic clipping[J]. Eur Rev Med Pharmacol Sci， 2012， 16(5)： 704-706.
9. Carbonell N， Pauwels A， Serfaty L， et al. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades[J]. Hepatology， 2004， 40(3)： 652-659.
10. Starzl TE， Marchioro TL， Vonkaulla KN， et al. Homotransplantation of the liver in humans[J]. Surg Gynecol Obstet， 1963， 117： 659-676.
11. Starzl TE， Fung JJ. Themes of liver transplantation[J]. Hepatology， 2010， 51(6)： 1869-1884.
12. Dienstag JL， Cosimi AB. Liver transplantation—a vision realized[J]. N Engl J Med， 2012， 367(16)： 1483-1485.
13. Orloff MJ. Portal hypertension and portacaval shunt// Souba W， Wilmore D. ed. Surgical Research[M]. Harcourt Brace：San Diego， 2001： 637-701.
14. Lata J， Hulek P， Vanasek T. Management of acute variceal bleeding[J]. Dig Dis， 2003， 21(1)： 6-15.
15. Garcia-Pagan JC， Caca K， Bureau C， et al. Early use of TIPS in patients with cirrhosis and variceal bleeding[J]. N Engl J Med 2010， 362(25)： 2370-2379.
16. Koizumi J， Hashimoto T， Myojin K， et al. Balloon-occluded retrograde transvenous obliteration of gastric varices：use ofCT-guided foam sclerotherapy to optimize technique[J]. AJR Am J Roentgenol， 2012， 199(1)： 200-207.
17. Tiuca N， Sztogrin W. The news of treatment of variceal upper gastrointestinal bleeding[J]. J Med Life， 2011， 4(4)：395-398.
18. Pomier-Layrargues G， Bouchard L， Lafortune M， et al. The transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension： current status[J]. Int J Hepatol， 2012， 167868 Epub 2012 Jul 19.
19. Klupp J， Kohler S， Pascher A， et al. Liver transplantation as ultimate tool to treat portal hypertension[J] . Dig Dis， 2005， 23(1)：65-71.
20. Henderson JM， Yang Y. Is there still a role for surgery in bleeding portal hypertension?[J]. Nat Clin Pract Gastroenterol Hepatol， 2005，2(6)： 246-247.
21. 严律南. 肝硬变门脉高压症的肝脏移植经验[J]. 中国普外基础与临床杂志， 2001， 19(9)： 951-956.
22. Organ procurement and transplantation network. Liver Kaplan-Meier median waiting times for registrations listed：1999-2004[DB/OL]. http：//www. optn. transplant. hrsa. gov. (accessed on 1 NoV. 2012).
23. Waiting time to transplant[DB/OL]. http：//www. organdonation. nhs. uk. (accessed on 1 NoV. 2012).
24. de Franchis R， Dell’Era A， Iannuzzi F. Diagnosis and treatment of portal hypertension[J]. Dig Liver Dis， 2004， 36(12)： 787-798.
25. Bismuth H， Adam R， Raccuia JS. 肝脏移植治疗门脉高压症[J]. 德国医学， 1996， 13(3)： 157-159.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis on Effect of Liver Transplantation in Treatment of Upper Gastrointestinal Hemorrhage in Patients with Portal Hypertension

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