The characteristics and risk factors of esophageal varices in patients post-liver transplantation

Abstract

Abstract: Objective To explore the risk factors and characteristics of esophageal varices in patients post-liver transplantation (LT). Methods This is a cross-section study retrospectively analyzed the data of patients post-LT who had a gastroscopy at the General hospital of the 5th medical center of Chinese People's Liberation Army from July 2011 to October 2021. Patients post-LT were classified into patients with and without esophageal varices via gastroendoscopy. Results Fifty-five cases were included in this study, with 26 patients among them with esophageal varices, and 29 cases without esophageal varices. Compared with those patients without esophageal varices, patients with esophageal varices had three characteristics: longer spleen length (117 mm vs 154 mm, P=0.001), lower platelet counts (136×10⁹/L vs 87×10⁹/L, P=0.015), and higher total bile acid level (6.0 μmol/L vs 24.5 μmol/L, P=0.001). Spleen length (OR=1.063, 95%CI=1.01~1.12, P=0.031) was the independent risk factor associated with esophageal varices. The area under the ROC curve for esophageal varices was 0.790 (95%CI=0.647~0.934, P=0.001) at the cutoff value was 143mm, the sensitivity was 91.3%, and specificity was 91.3%. Conclusion Spleen length is the independent risk factor associated with esophageal varices and had good discriminable power for esophageal varices after LT.

Key words: Post-liver transplantation, Esophageal varices, Spleen, Platelet, Total bile acid

XIANG Lu, ZHANG Li-juan, YANG Jun-lian,ZHANG Da-li, FENG Dan-ni. The characteristics and risk factors of esophageal varices in patients post-liver transplantation[J]. Chinese Hepatolgy, 2024, 29(1): 44-46.

References

[1] Ravaioli M, Lai Q, Sessa M, et al. Impact of MELD 30-allocation policy on liver transplant outcomes in Italy[J]. J Hepatol, 2022,76(3):619-627.
[2] Belli LS, Duvoux C, Artzner T, et al. Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: results of the ELITA/EF-CLIF collaborative study (ECLIS) [J]. J Hepatol, 2021,75(3):610-622.
[3] Unger LW, Berlakovich GA, Trauner M, et al. Management of portal hypertension before and after liver transplantation[J]. Liver Transpl, 2018,24(1):112-121.
[4] Korda D, Deak PA, Kiss G, et al. Management of portal hypertension after liver transplantation[J]. Transplant Proc, 2017,49(7):1530-1534.
[5] Gracia-Sancho J, Marrone G, Fernandez-Iglesias A. Hepatic microcirculation and mechanisms of portal hypertension[J]. Nat Rev Gastroenterol Hepatol, 2019,16(4):221-234.
[6] Pollok JM, Tinguely P, Berenguer M, et al. Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference[J]. Lancet Gastroenterol Hepatol, 2023, 8(1):81-94.
[7] Gana JC, Serrano CA, Ling SC. Angiogenesis and portal-systemic collaterals in portal hypertension[J]. Ann Hepatol, 2016,15(3):303-13.
[8] Li T, Yang Z. Research progress of vasculopathy in portal hypertension[J]. World J Gastroenterol, 2005,11(39):6079-84.
[9] Jiang WT, Yang J, Xie Y, et al. Simultaneous partial splenectomy during liver transplantation for advanced cirrhosis patients combined with severe splenomegaly and hypersplenism[J]. World J Gastroenterol, 2021,27(7):654-665.
[10] Sun X, Zhang A, Zhou T, et al. Partial splenic embolization combined with endoscopic therapies and NSBB decreases the variceal rebleeding rate in cirrhosis patients with hypersplenism: a multicenter randomized controlled trial[J]. Hepatol Int, 2021,15(3):741-752.
[11] Balcar L, Semmler G, Pomej K, et al. Patterns of acute decompensation in hospitalized patients with cirrhosis and course of acute-on-chronic liver failure[J]. United European Gastroenterol J, 2021,9(4):427-437.
[12] Rogalski P, Rogalska-Plonska M, Wroblewski E, et al. Blood platelet function abnormalities in cirrhotic patients with esophageal varices in relation to the variceal bleeding history[J]. Scand J Gastroenterol, 2019,54(3):311-318.
[13] 冯丹妮, 张达利, 贺希, 等. 酒精性肝硬化的肝移植受者血小板减少的病例对照研究[J]. 肝脏, 2022, 5(27):540-556.
[14] Alvaro D, Caporaso N, Giannini EG, et al. Procedure-related bleeding risk in patients with cirrhosis and severe thrombocytopenia[J]. Eur J Clin Invest, 2021,51(6):e13508.
[15] Pablo Arab J, Barrera F, Arrese M. Bile acids and portal hypertension[J]. Ann Hepatol, 2017,16 Suppl 1:S83-S86.
[16] Sauerbruch T, Hennenberg M, Trebicka J, et al. Bile acids, liver cirrhosis, and extrahepatic vascular dysfunction[J]. Front Physiol, 2021, 12:718783.
[17] Fiorucci S, Distrutti E. Targeting the transsulfuration-H2S pathway by FXR and GPBAR1 ligands in the treatment of portal hypertension[J]. Pharmacol Res, 2016,111:749-756.