Comparison on Effects of Liver Transplantation and Periesophagogastric Devascularization with Splenectomy for Portal Hypertension and Cirrhosis with Liver Function of Child Grade A_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Ming ,  WEN Tianfu , YAN Lnan , LI Chuan , ZHANG Yu

Division of Liver Transplantation Center， West China Hospital of Sichuan University， Chengdu 610041， Sichuan Province， China;

Corresponding author：

WEN Tianfu, Email: ccwentianfu@sohu.com

Keywords：

Portal hypertension; Liver function; Child A; Hepatits B cirrhosis; Liver transplantation; Periesophagogastric devascularization; Splenectomy

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Objective 　To approach the prognosis after liver transplantation （LT） of liver function for Child grade A in patients with portal hypertension， and to compare with periesophagogastric devascularization with splenectomy （PDS）.
Methods 　The data of 195 portal hypertension cases with Child A caused by hepatitis B cirrhosis who received surgical treatment of PDS （152 cases） or LT （43 cases） in division of liver transplantation center of West China Hospital of Sichuan University from 1999 to 2011 were retrospectively analyzed. The pre-， intra-， and postoperative variables in two groups that including patients’ age， score of Child， score of model for end-stage liver disease （MELD）， total bilirubin （TB），creatinine （Cr）， international normalized ratio （INR）， albumin （Alb）， complications of portal hypertension， amount of intraoperative bleeding and blood transfusion， operative time， and in the ICU and hospital stay time were compared. The postoperative outcomes were statistically analyzed including severe postoperative complications， short-term and long-term survival rates.
Results 　Compared with PDS group， the amount of intraoperative bleeding and blood transfusion of LT group were morer （P＜0.05）， the operative time， in the ICU and hospital stay time of LT group were longer （P＜0.05）. The rate of severe postoperative complications in LT group was higher than that in PDS group 〔18.60% （8/43） vs. 1.97% （3/152），P＜0.05〕. The levels of TB and Cr during the postoperative period in LT group were higher than that in PDS group （P＜0.05）. Although the INR on day 1 after operation in LT group was higher than that in PDS group （P＜0.01）， but the difference disappeared soon on day 7 after operation in two groups （P＞0.05）.The 1-， 3-， and 5-year survival rates of the LT and PDS groups were 90.3%， 86.5%， 86.5%， and 100%， 100%， 100%， respectively， significant difference were observed in both short-term and long-term survival rates between the two groups （P＜0.05）.
Conclusion 　LT offered no significant survival benefit to patients with portal hypertension and Child A due to hepatitis B cirrhosis， whereas PDS could be an effective treatment.

Citation： WANG Ming,WEN Tianfu,YAN Lnan,LI Chuan,ZHANG Yu. Comparison on Effects of Liver Transplantation and Periesophagogastric Devascularization with Splenectomy for Portal Hypertension and Cirrhosis with Liver Function of Child Grade A. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(1): 18-23. doi: Copy

1.	Klupp J， Kohler S， Pascher A， et al. Liver transplantation as ultimate tool to treat portal hypertension[J]. Dig Dis， 2005，23(1)：65-71.
2.	Henderson JM. Surgical treatment of portal hypertension[J]. Baillieres Best Pract Res Clin Gastroenterol， 2000， 14(6)：911-925.
3.	Makdissi FF， Herman P， Pugliese V， et al. Long-term results of esophagogastric devascularization and splenectomy associated with endoscopic treatment in schistosomal portal hypertension[J]. World J Surg， 2010， 34(11)：2682-2688.
4.	杨镇，裘法祖. 脾切除贲门周围血管离断术治疗门静脉高压症的疗效[J]. 中华外科杂志， 2000， 38(9)：645-648.
5.	Karara K， el-Gendi MA， Gertsch P， et al. Portal pressure measurements before and after Hassab’s decongestion operation. A preliminary report[J]. Int Surg， 1987， 72(3)：141-143.
6.	Zhang Y， Wen TF， Yan LN，et al. The changes of hepatic hemodynamics and functional hepatic reserve after splenectomy with periesophagogastric devascularization[J]. Hepatogastroenterology， 2009， 56(91-92)：835-839.
7.	Kapoor D， Sarin SK. Pathophysiology of portal hypertension[J]. J Gastroenterol Hepatol， 2002， 17 Suppl：S482-S487.
8.	Kinjo N， Kawanaka H， Akahoshi T， et al. Risk factors for portal venous thrombosis after splenectomy in patients with cirrhosis and portal hypertension[J]. Br J Surg， 2010， 97(6)：910-916.
9.	Lai CL， Chien RN， Leung NW， et al. A one-year trial of lamivudine for chronic hepatitis B.[J]. N Engl J Med， 1998， 339(2)：61-68.
10.	Dienstag JL， Schiff ER， Wright TL， et al. Lamivudine as initial treatment for chronic hepatitis B in the United States[J]. N Engl J Med， 1999， 341(17)：1256-1263.
11.	Goodman Z， Dhillon AP， Wu PC， et al. Lamivudine treatment reduces progression to cirrhosis in patients with chronic hepatitis B[J]. J Hepatol， 1999， 30(Suppl 1)：59.
12.	Dienstag JL， Goldin RD， Heathcote EJ， et al. Histological outcome during long-term lamivudine therapy[J]. Gastroenterology，2003， 124(1)：105-117.
13.	Hui JM， George J， Liddle C， et al. Changes in serum albumin during treatment of chronic hepatitis B with lamivudine：effects of response and emergence of drug resistance[J]. Am J Gastroenterol， 2002， 97(4)：1003-1009.
14.	Fontana RJ. Management of patients with decompensated HBV cirrhosis[J]. Semin Liver Dis， 2003， 23(1)：89-100.
15.	Perrillo RP， Wright T， Rakela J， et al. A multicenter United States-Canadian trial to assess lamivudine monotherapy before and after liver transplantation for chronic hepatitis B[J]. Hepatology， 2001， 33(2)：424-432.
16.	Li C， Mi K， Wen TF， et al. Outcome comparison of right hepatectomy for living liver donation versus for hepatic patients withoutcirrhosis[J]. Gastrointest Surg， 2011， 15(6)：982-987.
17.	Li C， Mi K， Wen TF， et al. Outcomes of patients with benign liver diseases undergoing living donor versus deceased donor liver transplantation[J]. PLoS One， 2011， 6(11)：e27366.
18.	Dindo D， Demartines N， Clavien PA. Classification of surgical complications：a new proposal with evaluation in a cohort of 6 336patients and results of a survey[J]. Ann Surg， 2004， 240(2)：205-213.
19.	Clavien PA， Barkun J， de Oliveira ML， et al. The Clavien-Dindo classification of surgical complications：five-year experience[J]. Ann Surg， 2009， 250(2)：187-196.
20.	Arroyo V， Gines P， Gerbes AL， et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis[J]. Hepatology， 1996， 23 (1)：164-176.
21.	周总光，赵玉沛. 外科学[M]. 北京：高等教育出版社， 2009：472.
22.	Kamath PS， Kim WR；Advanced Liver Disease Study Group. The model for end-stage liver disease (MELD)[J]. Hepatology， 2007， 45(3)：797-805.
23.	Zheng X， Liu Q， Yao Y. Laparoscopic splenectomy and esophagogastric devascularization is a safe， effective， minimally invasive alternative for the treatment of portal hypertension with refra-ctory variceal bleeding[J]. Surg Innov， 2012 Mar 28.[Epub ahead of print].
24.	Liaw YF， Sung JJ， Chow WC， et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease[J]. N Engl J Med， 2004， 351(15)：1521-1531.
25.	Freeman RB Jr， Stefﬁck DE， Guidinger MK， et al. Liver andintestine transplantation in the United States， 1997-2006[J]. Am J Transplant， 2008， 8(4 Pt 2)：958-976.
26.	Perkins JD， Halldorson JB， Bakthavatsalam R， et al. Should liver transplantation in patients with model for end-stage liverdisease scores≤14 be avoided? A decision analysis approach[J]. Liver Transpl， 2009， 15(2)：242-254.
27.	Schaubel DE， Sima CS， Goodrich NP， et al. The survival beneﬁt of deceased donor liver transplantation as a function of candidate disease severity and donor quality[J]. Am J Transplant， 2008， 8(2)：419-425.
28.	Merion RM， Schaubel DE， Dykstra DM， et al. The survival beneﬁt of liver transplantation[J]. Am J Transplant， 2005， 5(2)：307-313.

1. Klupp J， Kohler S， Pascher A， et al. Liver transplantation as ultimate tool to treat portal hypertension[J]. Dig Dis， 2005，23(1)：65-71.
2. Henderson JM. Surgical treatment of portal hypertension[J]. Baillieres Best Pract Res Clin Gastroenterol， 2000， 14(6)：911-925.
3. Makdissi FF， Herman P， Pugliese V， et al. Long-term results of esophagogastric devascularization and splenectomy associated with endoscopic treatment in schistosomal portal hypertension[J]. World J Surg， 2010， 34(11)：2682-2688.
4. 杨镇，裘法祖. 脾切除贲门周围血管离断术治疗门静脉高压症的疗效[J]. 中华外科杂志， 2000， 38(9)：645-648.
5. Karara K， el-Gendi MA， Gertsch P， et al. Portal pressure measurements before and after Hassab’s decongestion operation. A preliminary report[J]. Int Surg， 1987， 72(3)：141-143.
6. Zhang Y， Wen TF， Yan LN，et al. The changes of hepatic hemodynamics and functional hepatic reserve after splenectomy with periesophagogastric devascularization[J]. Hepatogastroenterology， 2009， 56(91-92)：835-839.
7. Kapoor D， Sarin SK. Pathophysiology of portal hypertension[J]. J Gastroenterol Hepatol， 2002， 17 Suppl：S482-S487.
8. Kinjo N， Kawanaka H， Akahoshi T， et al. Risk factors for portal venous thrombosis after splenectomy in patients with cirrhosis and portal hypertension[J]. Br J Surg， 2010， 97(6)：910-916.
9. Lai CL， Chien RN， Leung NW， et al. A one-year trial of lamivudine for chronic hepatitis B.[J]. N Engl J Med， 1998， 339(2)：61-68.
10. Dienstag JL， Schiff ER， Wright TL， et al. Lamivudine as initial treatment for chronic hepatitis B in the United States[J]. N Engl J Med， 1999， 341(17)：1256-1263.
11. Goodman Z， Dhillon AP， Wu PC， et al. Lamivudine treatment reduces progression to cirrhosis in patients with chronic hepatitis B[J]. J Hepatol， 1999， 30(Suppl 1)：59.
12. Dienstag JL， Goldin RD， Heathcote EJ， et al. Histological outcome during long-term lamivudine therapy[J]. Gastroenterology，2003， 124(1)：105-117.
13. Hui JM， George J， Liddle C， et al. Changes in serum albumin during treatment of chronic hepatitis B with lamivudine：effects of response and emergence of drug resistance[J]. Am J Gastroenterol， 2002， 97(4)：1003-1009.
14. Fontana RJ. Management of patients with decompensated HBV cirrhosis[J]. Semin Liver Dis， 2003， 23(1)：89-100.
15. Perrillo RP， Wright T， Rakela J， et al. A multicenter United States-Canadian trial to assess lamivudine monotherapy before and after liver transplantation for chronic hepatitis B[J]. Hepatology， 2001， 33(2)：424-432.
16. Li C， Mi K， Wen TF， et al. Outcome comparison of right hepatectomy for living liver donation versus for hepatic patients withoutcirrhosis[J]. Gastrointest Surg， 2011， 15(6)：982-987.
17. Li C， Mi K， Wen TF， et al. Outcomes of patients with benign liver diseases undergoing living donor versus deceased donor liver transplantation[J]. PLoS One， 2011， 6(11)：e27366.
18. Dindo D， Demartines N， Clavien PA. Classification of surgical complications：a new proposal with evaluation in a cohort of 6 336patients and results of a survey[J]. Ann Surg， 2004， 240(2)：205-213.
19. Clavien PA， Barkun J， de Oliveira ML， et al. The Clavien-Dindo classification of surgical complications：five-year experience[J]. Ann Surg， 2009， 250(2)：187-196.
20. Arroyo V， Gines P， Gerbes AL， et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis[J]. Hepatology， 1996， 23 (1)：164-176.
21. 周总光，赵玉沛. 外科学[M]. 北京：高等教育出版社， 2009：472.
22. Kamath PS， Kim WR；Advanced Liver Disease Study Group. The model for end-stage liver disease (MELD)[J]. Hepatology， 2007， 45(3)：797-805.
23. Zheng X， Liu Q， Yao Y. Laparoscopic splenectomy and esophagogastric devascularization is a safe， effective， minimally invasive alternative for the treatment of portal hypertension with refra-ctory variceal bleeding[J]. Surg Innov， 2012 Mar 28.[Epub ahead of print].
24. Liaw YF， Sung JJ， Chow WC， et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease[J]. N Engl J Med， 2004， 351(15)：1521-1531.
25. Freeman RB Jr， Stefﬁck DE， Guidinger MK， et al. Liver andintestine transplantation in the United States， 1997-2006[J]. Am J Transplant， 2008， 8(4 Pt 2)：958-976.
26. Perkins JD， Halldorson JB， Bakthavatsalam R， et al. Should liver transplantation in patients with model for end-stage liverdisease scores≤14 be avoided? A decision analysis approach[J]. Liver Transpl， 2009， 15(2)：242-254.
27. Schaubel DE， Sima CS， Goodrich NP， et al. The survival beneﬁt of deceased donor liver transplantation as a function of candidate disease severity and donor quality[J]. Am J Transplant， 2008， 8(2)：419-425.
28. Merion RM， Schaubel DE， Dykstra DM， et al. The survival beneﬁt of liver transplantation[J]. Am J Transplant， 2005， 5(2)：307-313.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison on Effects of Liver Transplantation and Periesophagogastric Devascularization with Splenectomy for Portal Hypertension and Cirrhosis with Liver Function of Child Grade A

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