Beneficial effects of living-donor liver transplantation on esophageal varices.
BACKGROUND
Liver transplantation (LT) is known to improve bleeding esophageal varices (EVs) and portal hypertension. However, many issues related to EVs after LT remain unresolved, such as whether LT reduces blood supply to EVs, improves the diameter of unruptured EVs, or improves or worsens EVs. The aim of this retrospective study was to determine the effects of living-donor liver transplantation (LDLT) in patients with hepatic failure on EVs and inflow vessels to EVs and the factors associated with deterioration of EVs after LDLT.


METHODS
The study subjects were 35 patients with cirrhosis who underwent LDLT. Endoscopy and multidetector helical computed tomography (MDCT) were performed before and after LDLT. The diameter of the inflow vessel of EVs was measured by MDCT before and after LDLT, together with the LDLT-related reduction rate of the diameter of the gastric vein (RRGV).


RESULTS
Endoscopic examination showed improvement of EVs in 30 of 35 (86%) patients. RRGV improved in 17/35 (49%) patients, did not change in 13/35 (37%), and deteriorated in 5/35 (14%). The cause of RRGV deterioration seemed to be either the complication of portal vein or graft failure. In patients examined endoscopically at >1 year after LDLT, improvement of EVs was associated with significant changes in the rate of reduction of the major inflow vessel diameter and Child-Pugh score, compared with those who showed no improvement.


CONCLUSIONS
LDLT results in improvement of EVs. EVs improved in 86% of the patients. Measurement of RRGV with MDCT is a good tool for prediction of EV improvement after LDLT.
Kawaoka
Tomokazu
T
Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
Takahashi
Shoichi
S
Aikata
Hiroshi
H
Azakami
Takahiro
T
Saneto
Hiromi
H
Takaki
Shintaro
S
Jeong
Soo Cheol
SC
Asahara
Toshimasa
T
Ito
Katsuhide
K
Chayama
Kazuaki
K
D000328:Adult; D000368:Aged; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000473:pathology; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D036542:Tomography, Spiral Computed