Liver transplantation in patients with liver cirrhosis and esophageal bleeding

Uncontrolled hemorrhage from esophageal varices is one of the most devastating complications of portal hypertension in patients with advanced cirrhosis.

Drug therapy, endoscopic therapy, transjugular intrahepatic portosystemic shunt (TIPS), or surgical shunts are used with increasing success in the prevention and treatment of bleeding. However, all these treatment modalities have limitations because they do not treat the liver cirrhosis itself. On the other hand, treatment modalities for variceal bleeding may influence the ease of the feasibility of the transplantation procedure. This is particularly the case for surgical treatments like portosystemic shunts and devascularization operations. For this reason these procedures should be avoided if possible. When positioned correctly, a TIPS provides an elegant way of treating portal hypertension without influencing the course of liver transplantation. Liver transplantation offers a treatment that cures both the portal hypertension and the liver disease. However, the use of this method of treatment is limited by the organ availability and by the organ allocation algorithm, resulting in considerable waiting time.

In conclusion, esophageal bleeding should be noticed as an early warning factor, leading the hepatologist to consider liver transplantation and early listing of the patient.