Rajoriya N, Tripathi D, Leithead JA, Gunson BK, Lord S, Ferguson JW, Hirschfield GM. Portal hypertension in polycystic liver disease patients does not affect wait-list or immediate post-liver transplantation outcomes. World J Gastroenterol 2016; 22(45): 9966-9973 [PMID: 28018103 DOI: 10.3748/wjg.v22.i45.9966]
Corresponding Author of This Article
Gideon M Hirschfield, Professor, Consultant Hepatologist, Centre for Liver Research, NIHR Birmingham Liver Biomedical Research Unit, University of Birmingham, Birmingham B152TT, United Kingdom. g.hirschfield@bham.ac.uk
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Dec 7, 2016; 22(45): 9966-9973 Published online Dec 7, 2016. doi: 10.3748/wjg.v22.i45.9966
Portal hypertension in polycystic liver disease patients does not affect wait-list or immediate post-liver transplantation outcomes
Neil Rajoriya, Dhiraj Tripathi, Joanna A Leithead, Bridget K Gunson, Sophie Lord, James W Ferguson, Gideon M Hirschfield
Neil Rajoriya, Dhiraj Tripathi, Joanna A Leithead, Bridget K Gunson, Sophie Lord, James W Ferguson, Gideon M Hirschfield, Liver Unit, Queen Elizabeth Hospital, Birmingham B152WB, United Kingdom
Joanna A Leithead, Bridget K Gunson, Gideon M Hirschfield, Centre for Liver Research, NIHR Birmingham Liver Biomedical Research Unit, University of Birmingham, Birmingham B152TT, United Kingdom
Author contributions: Rajoriya N wrote the manuscript, was involved with project concept and submission; Leithead JA assisted with statistics and discussions of project; Lord S involved with data collection; Ferguson JW and Hirschfield GM involved with project design/concept/review of manuscript; and Tripathi D involved with submission/review of manuscript; all the authors contributed to this manuscript.
Institutional review board statement: The research study was approved by the Queen Elizabeth Hospital, Birmingham local clinical audit committee (Application reference CAB: 04870-12). This paper presents independent research supported by the Birmingham NIHR Liver Biomedical Research Unit based at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Informed consent statement: Informed consent was gained from all study participants who were enrolled onto the transplant database.
Conflict-of-interest statement: The authors state no conflict on interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gideon M Hirschfield, Professor, Consultant Hepatologist, Centre for Liver Research, NIHR Birmingham Liver Biomedical Research Unit, University of Birmingham, Birmingham B152TT, United Kingdom. g.hirschfield@bham.ac.uk
Telephone: +44-121-4158700 Fax: +44-121-4158701
Received: July 1, 2016 Peer-review started: July 1, 2016 First decision: July 29, 2016 Revised: September 28, 2016 Accepted: November 14, 2016 Article in press: November 16, 2016 Published online: December 7, 2016 Processing time: 158 Days and 22.1 Hours
Abstract
AIM
To establish the impact of portal hypertension (PH) on wait-list/post-transplant outcomes in patients with polycystic liver disease (PCLD) listed for liver transplantation.
METHODS
A retrospective single-centre case controlled study of consecutive patients listed for liver transplantation over 12 years was performed from our centre. PH in the PCLD cohort was defined by the one or more of following parameters: (1) presence of radiological or endoscopic documented varices from our own centre or the referral centre; (2) splenomegaly (> 11 cm) on radiology in absence of splenic cysts accounting for increased imaging size; (3) thrombocytopenia (platelets < 150 × 109/L); or (4) ascites without radiological evidence of hepatic venous outflow obstruction from a single cyst.
RESULTS
Forty-seven PCLD patients (F: M = 42: 5) were listed for liver transplantation (LT) (single organ, n = 35; combined liver-kidney transplantation, n = 12) with 19 patients (40.4%) having PH. When comparing the PH group with non-PH group, the mean listing age (PH group, 50.6 (6.4); non-PH group, 47.1 (7.4) years; P = 0.101), median listing MELD (PH group, 12; non-PH group, 11; P = 0.422) median listing UKELD score (PH group, 48; non-PH group, 46; P = 0.344) and need for renal replacement therapy (P = 0.317) were similar. In the patients who underwent LT alone, there was no difference in the duration of ICU stay (PH, 3 d; non-PH, 2 d; P = 0.188), hospital stay length (PH, 9 d; non-PH, 10 d; P = 0.973), or frequency of renal replacement therapy (PH, 2/8; non-PH, 1/14; P = 0.121) in the immediate post-transplantation period.
CONCLUSION
Clinically apparent portal hypertension in patients with PCLD listed for liver transplantation does not appear to have a major impact on wait-list or peri-transplant morbidity.
Core tip: Clinically apparent portal hypertension is common in patients with polycystic liver disease, however it appears that this finding does not affect wait list or post-transplantation outcomes in the short-term.
