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Updated: Jul 1, 2025
Heterotopic Auxiliary Rat Liver Transplantation With Flow-regulated Portal Vein Arterialization in Acute Hepatic Failure
Published on: September 13, 2014
Referral for liver transplant following acute variceal bleeding: a multicenter cohort study
Sofia Bragança1, Marta Ramos2, Sara Lopes3
1Gastroenterology Division, Fernando Fonseca Hospital, Amadora.
Insights
Referral for liver transplant (LT) after acute variceal bleeding (AVB) is low. Early LT evaluation in cirrhosis patients with AVB significantly reduces long-term mortality.
Area of Science:
- Hepatology
- Transplantation Medicine
- Gastroenterology
Background:
- Acute variceal bleeding (AVB) is a serious complication of cirrhosis.
- Referral patterns for liver transplant (LT) following AVB are inconsistent.
- The impact of LT referral on patient outcomes after AVB requires further characterization.
Purpose of the Study:
- To characterize LT referral practices in cirrhosis patients experiencing AVB.
- To assess the association between LT referral and clinical outcomes, specifically all-cause mortality.
Main Methods:
- Retrospective observational cohort study of 143 cirrhosis patients with AVB from three Lisbon hospitals (2018-2019).
- Primary exposure: referral for LT. Primary endpoint: all-cause mortality within two years of hospital admission.
- Confounder adjustment was performed for statistical analysis.
Main Results:
- Only 21.0% of patients were evaluated for LT, with 9.1% evaluated before admission and 11.9% within two years.
- Liver transplant was performed in only 2.1% of patients.
- Referral for LT was associated with a significant reduction in 2-year all-cause mortality (aHR: 0.20; 95% CI: 0.05-0.85) after adjusting for confounders.
Conclusions:
- Less than a quarter of cirrhosis patients with AVB received a formal LT evaluation in this multicenter cohort.
- Improved and timely referral for LT evaluation following AVB could potentially improve long-term survival in these high-risk patients.
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.
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