Emhmed Ali S, Benrajab KM, Dela Cruz AC. Outcome of gastric antral vascular ectasia and related anemia after orthotopic liver transplantation. World J Hepatol 2020; 12(11): 1067-1075 [PMID: 33312430 DOI: 10.4254/wjh.v12.i11.1067]
Corresponding Author of This Article
Karim M Benrajab, MD, Assistant Professor, Division of Digestive Diseases and Nutrition, Department of Internal Medicine, University of Kentucky College of Medicine, 800 Rose Street, MN649, Lexington, KY 40536, United States. karimbenrajab@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective 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 Hepatol. Nov 27, 2020; 12(11): 1067-1075 Published online Nov 27, 2020. doi: 10.4254/wjh.v12.i11.1067
Outcome of gastric antral vascular ectasia and related anemia after orthotopic liver transplantation
Saad Emhmed Ali, Karim M Benrajab, Anna Christina Dela Cruz
Saad Emhmed Ali, Division of Hospital Medicine, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40536, United States
Karim M Benrajab, Anna Christina Dela Cruz, Division of Digestive Diseases and Nutrition, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40536, United States
Author contributions: Emhmed Ali S and Dela Cruz AC provided the conception and designed the study; Emhmed Ali S, Benrajab K and Dela Cruz AC analyzed and interpreted the data and wrote the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the University of Kentucky Institutional Review Board (Approval No 54669).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: Authors have no relevant relationships or conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Karim M Benrajab, MD, Assistant Professor, Division of Digestive Diseases and Nutrition, Department of Internal Medicine, University of Kentucky College of Medicine, 800 Rose Street, MN649, Lexington, KY 40536, United States. karimbenrajab@gmail.com
Received: July 27, 2020 Peer-review started: July 27, 2020 First decision: September 21, 2020 Revised: October 4, 2020 Accepted: October 26, 2020 Article in press: October 26, 2020 Published online: November 27, 2020
ARTICLE HIGHLIGHTS
Research background
Gastric antral vascular ectasia (GAVE) is a well-recognized cause of gastrointestinal bleeding in cirrhotic patients. The etiology of GAVE remains unclear, although several humoral, autoimmune, mechanical stress, and pharmacological (proton pump inhibitor use) hypotheses have been described. Different treatment modalities have been proposed with varying results. Orthotopic liver transplantation (OLT), which is often recommended for patients with significant complications due to end-stage liver disease, has also been shown to be beneficial treatment for resolution of GAVE and associated anemia in a few small studies.
Research motivation
To evaluate the relation between GAVE and associated anemia and OLT.
Research objectives
To assess the impact of OLT on resolution of the natural course of GAVE and associated anemia.
Research methods
A retrospective chart review was conducted of adult patient with GAVE who underwent liver transplant between September 2012 and September 2019. Demographics and other relevant findings, including hemoglobin levels, Model of End-stage Liver Disease-sodium score, GAVE presentation, and upper endoscopy findings before and after OLT were collected.
Research results
Sixteen patients were identified, all Caucasians and predominantly female (62.5%) with a mean age of 56.5 years. The most common etiology for cirrhosis was NASH (44%). All patients presented with anemia, with 50% presenting with overt bleed and required transfusions prior to transplant. Mean pre-OLT Hgb was 7.7, and the mean 12 mo post-OLT Hgb was 11.9 (P = 0.001). Anemia improved in 87.5% of patients (n = 14) within 6 to 12 mo after OLT and resolved completely in half of the patients. Post-OLT esophagogastroduodenoscopy was performed in 10 patients, and GAVE resolved entirely in 6 of those patients (60%).
Research conclusions
Although GAVE and associated anemia completely resolved in the majority of our patients after liver transplantation, GAVE persisted in a few patients after transplant.
Research perspectives
Large prospective studies are needed to better understand what factors may contribute to persistent GAVE post-liver transplant.
