The analysis of upper gastrointestinal hemorrhage on the efficacy of liver transplantation in the treatment of cirrhotic portal hypertension

Objective To investigate the effect of upper gastrointestinal hemorrhage on the efficacy of liver transplantation in the treatment of cirrhotic portal hypertension (PHT). Methods The clinical data of the recipients who underwent liver transplantation due to cirrhotic PHT from January 2005 to September 2017 in the Department of Hepatobiliary Surgery of the Chinese People′s Liberation Army 900th Hospital of the Joint Logistics Team were analyzed retrospectively. All the recipients were divided into bleeding group and non-bleeding group according to whether they had the upper gastrointestinal bleeding occurred before liver transplantation. The parameters including gender, age, amount of intraoperative bleeding and blood transfusion, days of hospitalization, cost of hospitalization and the liver function indexes before and after liver transplantation were observed. Wilcoxn signed rank sum test was used to compare the age, the amount of intraoperative bleeding and blood transfusion, the cost of hospitalization and the days of hospitalization between the two groups. ALT, AST, total bilirubin (TBil), albumin (ALB) and prothrombin time (PT) between the two groups were compared by group t test. Two-factor repeated data analysis of variance was used to compare the liver function indexes at each time point within 1 week after liver transplantation between the two groups. Chi-square test was used to compare the gender and primary diseases of the two groups. P<0.05 means statistically significant. Results A total of 80 cases (61 males and 19 females, aged 7-71 years old) underwent liver transplantation due to cirrhotic PHT. Primary diseases included 71 cases of posthepatitic cirrhosis, 5 cases of biliary cirrhosis, 2 cases of hepatolenticular cirrhosis and 2 cases of alcoholic cirrhosis. All subjects underwent orthotopic inferior vena cava reverse perfusion liver transplantation. There was no significant difference between the bleeding group (39 cases) and the non-bleeding group (41 cases) in gender, age, primary disease, preoperative liver function indexes, amount of intraoperative bleeding and blood transfusion, cost of hospitalization and days of hospitalization (P all>0.05). There was no significant difference in ALT, AST, TBil, ALB and PT between the two groups at all time points after operation (P all>0.05). The levels of serum ALT on the 3rd, 5th and 7th day after operation in both groups were lower than those on the 1st day after operation. The levels of serum ALT on the 5th and 7th day after operation in both groups was lower than those on the 3rd day after operation. The level of serum ALT on the 7th day after operation was lower than that on the 5th day after operation in the non-bleeding group (P all>0.05). Conclusion The history of upper gastrointestinal bleeding before liver transplantation had no effect on the early liver function after liver transplantation in the treatment of cirrhotic PHT. Key words: Liver transplantation; Portal hypertension; Esophageal and gastric varices; Cirrhosis; Upper gastrointestinal hemorrhage