5 years ago

Management of portal hypertension before and after liver transplantation.

Unger LW, Trauner M, Berlakovich G, Reiberger T
Orthotopic liver transplantation (OLT) represents a curative treatment option for end-stage liver disease (ESLD). While epidemiology of ESLD has recently changed due the rising prevalence of non-alcoholic fatty liver disease (NAFLD) and decreased burden of hepatitis C virus (HCV) infections due to highly-effective antiviral regimens, the management of portal hypertension (PHT) remains a clinical challenge in the pre- and post-OLT setting. The measurement of hepatic venous pressure gradient (HVPG) represents the most reliable, but invasive tool for assessment of the severity of PHT. Although novel liver ultrasound and MR-based elastography methods have been developed, their value to screen for liver fibrosis and PHT in transplanted patients remains to be established. Non-selective beta-blockers (NSBBs) represent the cornerstone of medical treatment of PHT, but more studies on their effects on clinical endpoints after OLT are needed. Statins are widely used to treat hyperlipidemia - a common condition after OLT. While a growing body of evidence suggests that statins decrease portal pressure and PHT-related complications in ESLD, studies on potential benefits of statins after OLT are lacking. Finally, transjugular intrahepatic portosystemic shunts (TIPS) are effective in decreasing PHT and seem to decrease mortality on the OLT waiting list. Moreover, TIPS does not impact on liver function nor complicate the transplant surgical procedures. TIPS may also be used post OLT but the evidence is limited. In conclusion, while the management of PHT in patients with ESLD is based on strong evidence, further data on the value of non-invasive monitoring tools, as well as on medical and invasive treatment options in the post-OLT setting are needed to improve management strategies in patients with recurrent PHT after liver transplantation. This article is protected by copyright. All rights reserved.

Publisher URL: https://www.ncbi.nlm.nih.gov/pubmed/28752925

DOI: PubMed:28752925

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