Liver Transplantation in the Treatment of Bleeding Oesophageal Varices

S. lwatsuki, T.E. Starzl, S. Todo, R.D. Gordon, A.G. Tzakis, J. W. Marsh, L. Makowka, B. Koneru, A. Stieber, G. Klintmalm, B. Husberg, D. van Thiel. (1988) Liver transplantation in the treatment ofbleeding esophageal varices. Surgery, 104; 697-705. From March 1980 to July 1987, 1000 patients with various end-stage liver diseases received orthotopic liver transplants. Ofthe 1000 patients, three hundred two had definite histories of bleeding from esophageal varices before transplantation. There were 287 patients with nonalcoholic liver diseases and 15 patients with alcoholic cirrhosis. All patients had very poor liver function, which was the main indication for liver transplantation. Onethrough 5-year actuarial survival rates of the 302 patients were 79%, 74%, 71%, 71%, and 71%, respectively. These survival rates are far better than those obtained with other available modes of treatment for bleeding varices when liver disease is advanced. Long-term sclerotherapy is the treatment of primary choice for bleeding varices. Patients in whom sclerotherapy fails should be considered for liver transplantation unless clear contraindications exist.