TY - JOUR
T1 - Referral for liver transplant following acute variceal bleeding
T2 - a multicenter cohort study
AU - Bragança, Sofia
AU - Ramos, Marta
AU - Lopes, Sara
AU - Alexandrino, Gonçalo
AU - Mendes, Milena
AU - Perdigoto, Rui
AU - Coimbra, João
AU - Marques, Hugo P
AU - Cardoso, Filipe S
PY - 2024/5/1
Y1 - 2024/5/1
N2 - OBJECTIVES: Referral for liver transplant (LT) following acute variceal bleeding (AVB) varies widely. We aimed to characterize and assess its impact on clinical outcomes.METHODS: Observational retrospective cohort including cirrhosis patients with AVB from 3 hospitals in Lisbon, Portugal, from 2018 to 2019. Primary exposure was referral for LT and primary endpoint was all-cause mortality within 2 years of index hospital admission.RESULTS: Among 143 patients, median (IQR) age was 59 (52-72) years and 90 (62.9%) were males. Median (IQR) MELDNa scores on hospital admission and discharge were 15 (11-21) and 13 (10-16), respectively. Overall, 30 (21.0%) patients were assessed for LT, 13 (9.1%) prior to and 17 (11.9%) within 2 years of hospital admission. Overall, 58 (40.6%) patients had at least one potential contra-indication for transplant. LT was performed in 3 (2.1%) patients (among 5 listed). Overall, 34 (23.8%) and 62 (43.4%) patients died at 6 weeks and 2 years post hospital admission, respectively. Following adjustment for confounders, referral for LT was associated with lower 2-year mortality (aHR (95% CI) = 0.20 (0.05-0.85)).CONCLUSION: In a multicenter cohort of cirrhosis patients with AVB, less than a quarter underwent formal LT evaluation. Improved referral for LT following AVB may benefit cirrhosis patients' longer-term mortality.
AB - OBJECTIVES: Referral for liver transplant (LT) following acute variceal bleeding (AVB) varies widely. We aimed to characterize and assess its impact on clinical outcomes.METHODS: Observational retrospective cohort including cirrhosis patients with AVB from 3 hospitals in Lisbon, Portugal, from 2018 to 2019. Primary exposure was referral for LT and primary endpoint was all-cause mortality within 2 years of index hospital admission.RESULTS: Among 143 patients, median (IQR) age was 59 (52-72) years and 90 (62.9%) were males. Median (IQR) MELDNa scores on hospital admission and discharge were 15 (11-21) and 13 (10-16), respectively. Overall, 30 (21.0%) patients were assessed for LT, 13 (9.1%) prior to and 17 (11.9%) within 2 years of hospital admission. Overall, 58 (40.6%) patients had at least one potential contra-indication for transplant. LT was performed in 3 (2.1%) patients (among 5 listed). Overall, 34 (23.8%) and 62 (43.4%) patients died at 6 weeks and 2 years post hospital admission, respectively. Following adjustment for confounders, referral for LT was associated with lower 2-year mortality (aHR (95% CI) = 0.20 (0.05-0.85)).CONCLUSION: In a multicenter cohort of cirrhosis patients with AVB, less than a quarter underwent formal LT evaluation. Improved referral for LT following AVB may benefit cirrhosis patients' longer-term mortality.
KW - Male
KW - Humans
KW - Middle Aged
KW - Aged
KW - Female
KW - Liver Transplantation/adverse effects
KW - Retrospective Studies
KW - Esophageal and Gastric Varices/surgery
KW - Gastrointestinal Hemorrhage/surgery
KW - Liver Cirrhosis/complications
KW - cirrhosis
KW - mortality
KW - transplant
KW - variceal bleed
UR - http://www.scopus.com/inward/record.url?scp=85189330937&partnerID=8YFLogxK
U2 - 10.1097/MEG.0000000000002749
DO - 10.1097/MEG.0000000000002749
M3 - Article
C2 - 38477864
SN - 0954-691X
VL - 36
SP - 657
EP - 664
JO - European Journal Of Gastroenterology & Hepatology
JF - European Journal Of Gastroenterology & Hepatology
IS - 5
ER -