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Chirurgia 1999 April;12(2):79-86


language: Italian

Liver transplantation and porto-systemic shunt in the treatment of cirrhotic patients with portal hypertension. An attempt to comparison

Cordovana A., Santambrogio R., Pisani Ceretti A., Intra M., Ballarini C., Houssein D., Spina G.


Background. Liver Transplantation (LT) is the only therapy that solves the problem of variceal bleeding and the underlying liver disease. However, few information are available on which patients with portal hypertension are the best candidates to LT or Porto-Systemic Shunt (PSS).
Methods. From January 1986 to December 1991, 59 patients with cirrhosis and portal hypertension had LT in Paris Center while 83 patients had PSS in Milan Center. Their data were retrospectively reviewed to obtain homogeneous collection in a dedicated data-base. From among PSS group a selected group of 59 patients was chosen to match approximate age, sex, severity of disease, etiology of cirrhosis and previous episodes of encephalopaty.
Results. No significant differences were found between LT and PSS group as regards as sex, age, etiology of cirrhosis and previous episodes of encephalopathy, respectively; however LT group enrolled higher number (30 vs 5 cases) of Child's C patients than PSS (p=0.0001). According to the degree of liver failure, 5-years survival was 76% for Child's A-B patients and 0% for C patients in PSS group (p=0.00894) and 45% and 57% in LT group, respectively (p=NS).
Conclusions. In conclusion, in cirrhotic patients with severe portal hypertension and liver failure, LT is an excellent mode of therapy. In grade A cirrhotics, PSS appears to be the optimum treatment. In grade B cirrhotics, both PSS and LT are good treatment options: generally if the sclerotherapy fails to reduce the risk of bleeding, the surgical choice is influenced by the availability of donor organs and by the probability whether or not the patient will eventually develop liver failure at any point following the shunt: in fact prior PSS can compromise the transplant operation and impair the outcome.

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