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Beta‐blockers in patients with advanced liver disease: Has the dust settled?
Author(s) -
MoctezumaVelazquez Carlos,
Kalainy Sylvia,
Abraldes Juan G.
Publication year - 2017
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.24794
Subject(s) - medicine , liver transplantation , observational study , cirrhosis , intensive care medicine , liver disease , portal hypertension , ascites , refractory (planetary science) , disease , transplantation , physics , astrobiology
Nonselective beta‐blockers (NSBBs) have been the backbone for the treatment of portal hypertension in cirrhosis for the last 3 decades. A publication in 2010 of a prospective observational study suggested that NSBBs could increase mortality in patients with refractory ascites. This opened a controversy about the safety and efficacy of NSBBs in patients with advanced liver disease and led to the publication of a large corpus of observational data assessing the safety of NSBBs in patients with advanced cirrhosis. In this article, we briefly review the clinical pharmacology of NSBBs, the pathophysiological basis for the underlying benefits and harms of NSBBs in advanced cirrhosis, and the evidence in favor and against the use of NSBBs in specific scenarios. Finally, we summarize the current recommendations and propose areas of opportunity for future research. Liver Transplantation 23 1058–1069 2017 AASLD.