Primary Prophylaxis for Gastrointestinal Bleeding in Children With Biliary Atresia and Portal Hypertension Candidates for Liver Transplantation

A Single-Center Experience

R. Angelico, A. Pietrobattista, M. Candusso, S. Tomarchio, M. Pellicciaro, D. Liccardo, M. S. Basso, C. Grimaldi, M. C. Saffioti, F. Torroni, L. Dall'Oglio, G. Torre, M. Spada

Research output: Contribution to journalArticle

Abstract

Background: Cirrhosis for biliary atresia (BA) is associated with risk of gastrointestinal bleeding (GB) from gastroesophageal varices due to portal hypertension. Primary prophylaxis of GB is controversial in children who are candidates for liver transplantation (LT). The aim of the study was to define the management of gastroesophageal varices and to identify the benefit of primary prophylaxis for GB in BA children waiting for LT. Methods: A retrospective single-center study including all BA children listed for LT in 2008–2016. Clinical, endoscopical, and biochemical data were analyzed. Results: Of 82 children, 50 (61%) did not receive primary prophylaxis and did not present any episode of bleeding, 16 (19.5%) underwent primary prophylaxis, and 16 (19.5%) presented spontaneous GB and received secondary prophylaxis. Children without primary prophylaxis and GB were younger than patients with primary prophylaxis and those with GB (7.7 years [range, 4.1–37.9 years] vs 11.2 years [range, 5.1–43 years]; P =.03 vs 10.7 years [range, 6.9–39.9 years], respectively; P =.004). Seventy-five percent of GB occurred in children older than 8 months. Fifteen (93.8%) children with GB presented esophageal varices (grade III = 10 [62.5%]) and 10 (62.5%) required endoscopic treatments, consisting mainly of sclerotherapy. Median time to LT was similar for children with or without bleeding (2 months [range, 0–17.7 months] vs 2.2 months [0–17.9 months], respectively; P =.89). After 45.5 months (range, 13.7–105.5 months) of follow-up, the overall patient survival was 97.6%. At the intention-to-treat analysis, the survival rate was 100% for patients without bleeding episode and 87.5% for children with GB (P =.16). Conclusions: Despite the risk of GB being not clinically predictable in children with BA waiting for LT, our experience suggests that primary prophylaxis of GB might be unnecessary in children younger than 6 months, while it should be considered in older children. Thus, the occurrence of GB does not delay the timing of transplantation.

Original languageEnglish
Pages (from-to)171-178
Number of pages8
JournalTransplantation Proceedings
Volume51
Issue number1
DOIs
Publication statusPublished - Jan 1 2019

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Biliary Atresia
Portal Hypertension
Liver Transplantation
Hemorrhage
Varicose Veins
Intention to Treat Analysis
Sclerotherapy
Esophageal and Gastric Varices

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Primary Prophylaxis for Gastrointestinal Bleeding in Children With Biliary Atresia and Portal Hypertension Candidates for Liver Transplantation : A Single-Center Experience. / Angelico, R.; Pietrobattista, A.; Candusso, M.; Tomarchio, S.; Pellicciaro, M.; Liccardo, D.; Basso, M. S.; Grimaldi, C.; Saffioti, M. C.; Torroni, F.; Dall'Oglio, L.; Torre, G.; Spada, M.

In: Transplantation Proceedings, Vol. 51, No. 1, 01.01.2019, p. 171-178.

Research output: Contribution to journalArticle

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abstract = "Background: Cirrhosis for biliary atresia (BA) is associated with risk of gastrointestinal bleeding (GB) from gastroesophageal varices due to portal hypertension. Primary prophylaxis of GB is controversial in children who are candidates for liver transplantation (LT). The aim of the study was to define the management of gastroesophageal varices and to identify the benefit of primary prophylaxis for GB in BA children waiting for LT. Methods: A retrospective single-center study including all BA children listed for LT in 2008–2016. Clinical, endoscopical, and biochemical data were analyzed. Results: Of 82 children, 50 (61{\%}) did not receive primary prophylaxis and did not present any episode of bleeding, 16 (19.5{\%}) underwent primary prophylaxis, and 16 (19.5{\%}) presented spontaneous GB and received secondary prophylaxis. Children without primary prophylaxis and GB were younger than patients with primary prophylaxis and those with GB (7.7 years [range, 4.1–37.9 years] vs 11.2 years [range, 5.1–43 years]; P =.03 vs 10.7 years [range, 6.9–39.9 years], respectively; P =.004). Seventy-five percent of GB occurred in children older than 8 months. Fifteen (93.8{\%}) children with GB presented esophageal varices (grade III = 10 [62.5{\%}]) and 10 (62.5{\%}) required endoscopic treatments, consisting mainly of sclerotherapy. Median time to LT was similar for children with or without bleeding (2 months [range, 0–17.7 months] vs 2.2 months [0–17.9 months], respectively; P =.89). After 45.5 months (range, 13.7–105.5 months) of follow-up, the overall patient survival was 97.6{\%}. At the intention-to-treat analysis, the survival rate was 100{\%} for patients without bleeding episode and 87.5{\%} for children with GB (P =.16). Conclusions: Despite the risk of GB being not clinically predictable in children with BA waiting for LT, our experience suggests that primary prophylaxis of GB might be unnecessary in children younger than 6 months, while it should be considered in older children. Thus, the occurrence of GB does not delay the timing of transplantation.",
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T2 - A Single-Center Experience

AU - Angelico, R.

AU - Pietrobattista, A.

AU - Candusso, M.

AU - Tomarchio, S.

AU - Pellicciaro, M.

AU - Liccardo, D.

AU - Basso, M. S.

AU - Grimaldi, C.

AU - Saffioti, M. C.

AU - Torroni, F.

AU - Dall'Oglio, L.

AU - Torre, G.

AU - Spada, M.

PY - 2019/1/1

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N2 - Background: Cirrhosis for biliary atresia (BA) is associated with risk of gastrointestinal bleeding (GB) from gastroesophageal varices due to portal hypertension. Primary prophylaxis of GB is controversial in children who are candidates for liver transplantation (LT). The aim of the study was to define the management of gastroesophageal varices and to identify the benefit of primary prophylaxis for GB in BA children waiting for LT. Methods: A retrospective single-center study including all BA children listed for LT in 2008–2016. Clinical, endoscopical, and biochemical data were analyzed. Results: Of 82 children, 50 (61%) did not receive primary prophylaxis and did not present any episode of bleeding, 16 (19.5%) underwent primary prophylaxis, and 16 (19.5%) presented spontaneous GB and received secondary prophylaxis. Children without primary prophylaxis and GB were younger than patients with primary prophylaxis and those with GB (7.7 years [range, 4.1–37.9 years] vs 11.2 years [range, 5.1–43 years]; P =.03 vs 10.7 years [range, 6.9–39.9 years], respectively; P =.004). Seventy-five percent of GB occurred in children older than 8 months. Fifteen (93.8%) children with GB presented esophageal varices (grade III = 10 [62.5%]) and 10 (62.5%) required endoscopic treatments, consisting mainly of sclerotherapy. Median time to LT was similar for children with or without bleeding (2 months [range, 0–17.7 months] vs 2.2 months [0–17.9 months], respectively; P =.89). After 45.5 months (range, 13.7–105.5 months) of follow-up, the overall patient survival was 97.6%. At the intention-to-treat analysis, the survival rate was 100% for patients without bleeding episode and 87.5% for children with GB (P =.16). Conclusions: Despite the risk of GB being not clinically predictable in children with BA waiting for LT, our experience suggests that primary prophylaxis of GB might be unnecessary in children younger than 6 months, while it should be considered in older children. Thus, the occurrence of GB does not delay the timing of transplantation.

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