The Findings of Upper Gastrointestinal Endoscopy Before and After the Living-Donor Liver Transplantation: Reflux Esophagitis Is the Frequent Complication after the Transplantation

Abstract

Portal hypertension, stress induced by operation, immunosupressive agents, and Helicobacter pylori may affect the findings of upper gastrointestinal endoscopy before and after the liver transplantation. Relatively small graft is one of characteristics of living-donor liver transplantation. The effects of living-donor liver transplantation on upper gastrointestinal endoscopic finding have not been examined well. Patients and Methods: Twenty-eight adult patients underwent living-donor liver transplantation were included in the present study. Upper gastrointestinal endoscopy was performed in 20 patients before and 22 patients after the transplantation. Results: Esophageal varix was seen in all of 18 cases with liver cirrhosis before transplantation. All of them were disappeared after transplantation. Portal hypertensive gastropathy was positive in 65% of patients. Twelve patients were classified as mild and one patient was classified as severe (McCormack's classification). According to Toyonaga's classification, 8 patients were classified as grade 1 and 4 patients were classified as grade 2. All of them were disappeared after the transplantation. Only 1 patient (5.0%) had grade A (Los Angeles classification) esophagitis before the transplantation. However, 6 out of 22 (27.3%) patients (grade C: 2, grade B: 1, grade A: 1, discoloring type: 2) had reflux esophagitis after the transplantation. Two patients had gastric or duodenal ulcer before the transplantation, however, no patient suffered from gastric nor duodenal ulcer after the transplantation. Before the transplantation, Helicobacter pylori positive rate was 33.3% (3/9). After the transplantation, only 1 out of 21 (4.8%) patients were Helicobacter pylori positive by culture of the gastric mucosa. Number of isolated bacteria by general microbiological culture of the gastric mucosa was not increased in the patients after the transplantation compared with control patients. Conclusion: The living-donor liver transplantation had curative effects on esophageal varix and portal hypertensive gastropathy. However, reflux esophagitis was a complication encountered following liver transplantation. Helicobacter pylori positive rate was low in the patients after the liver transplantation.