Clinical

Variceal bleeding alone may not warrant liver transplant in CF

Last Updated: 2005-12-09 15:46:51 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Liver transplant may not be indicated in cystic fibrosis (CF) patients with variceal bleeding but no other signs of liver decompensation, a new study shows.

Given the poor prognosis among cirrhotic patients with variceal bleeding, Dr. Ian Gooding of Central Middlesex Hospital in London and colleagues note, such bleeding has been considered an indication for liver transplant in CF patients with adequate lung function and those who are not considered lung or heart-lung transplant candidates.

But treating CF patients based on prognostic information from cirrhosis patients may not be appropriate, Dr. Gooding and his team note. To investigate, they looked at 18 CF patients with variceal bleeding, and compared them with a group of 36 CF patients without liver involvement.

Median survival after the first bleed (occurring at a median age of 20 years) was 8.4 years, compared with 13 years from the same time point in the control patients, not a significant difference. Thirty-eight bleeding episodes occurred in total, with only one death possibly resulting from a bleed. Most episodes were adequately controlled through endoscopic and supportive measures, with additional intervention necessary in only four episodes.

While ascites were seen in 11 of the patients, they were frequently transient, Dr. Gooding and his team note.

"Our data suggest that a history of variceal bleeding in the absence of decompensated cirrhosis can usually be managed without liver replacement," they conclude in the December issue of Liver Transplantation.

While liver transplant still has a role in CF treatment, Dr. Maureen M. Jonas of Children's Hospital in Boston comments in an accompanying editorial, these new findings suggest it should not be used to manage portal hypertension alone, but should be restricted to patients with "evidence of true hepatocellular dysfunction and failure."

Liver Transpl 2005;11:1463-1465,1522-1526.