Liver transplantation for portal hypertension

Liver transplantation is among the therapies that may be required for patients with variceal bleeding. The indication for transplantation is end-stage liver disease, not the variceal bleeding per se. Selection of patients is based on full evaluation that includes medical necessity, absence of medical contraindication, and psychosocial suitability. Decision algorithms for variceal bleeding must recognize that transplantation may be the endpoint of treatment, and other treatments should take this into consideration. Specific problems related to prior surgery for variceal bleeding should be defined before transplantation, and management strategies should be determined. The outcome for patients with end-stage cirrhosis and variceal bleeding has been dramatically improved by addition of transplantation to the treatment options.