Management of variceal bleeding in the liver transplant waiting list

Abstract

Objective: to study the outcomes of main surgical methods for stopping and preventing variceal hemorrhage in waitlisted cirrhotic patients. Material and methods. In our prospective case-control study, the «case» cohort included 132 patients with cirrhosis complicated by recurrent varicose bleeding, while the «control» group consisted of 92 patients with one episode of bleeding esophageal varices. Treatment included conservative therapy, endoscopic ligation, transjugular intrahepatic portosystemic shunt, and the original azygoportal disconnection technique. Results. High MELD scores, severe hepatic encephalopathy, portal vein thrombosis, high degree of varices, and recurrent bleeding significantly affect the mortality of cirrhotic patients. Irrational use of nonselective beta-blocker monotherapy has a negative impact on treatment outcomes. Combined use of drug therapy and surgical methods of stopping and preventing varicose bleeding, reduces the number of relapses, prolongs patients’ life to two years or more, which allows to move on to the next stage of cirrhosis treatment – liver transplantation. Conclusion. The likelihood of recurrent variceal hemorrhage increases in patients who undergo passive surgical tactics. Azygoportal disconnection should be considered as the operation of choice if the patient has more than one episode of variceal bleeding. Timely and adequate treatment measures, clinical and diagnostic monitoring reduce waitlist mortality.