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A randomized study comparing ligation with propranolol for primary prophylaxis of variceal bleeding in candidates for liver transplantation

Department of Surgical and Gastroenterological Sciences, 1st Surgical Clinic, Surgical Endoscopy Unit, University of Padova, Padova, Italy.
Liver Transplantation (Impact Factor: 3.79). 09/2007; 13(9):1272-8. DOI: 10.1002/lt.21083
Source: PubMed

ABSTRACT Whether beta-blockers (BB) or banding is the best therapy for primary prophylaxis of variceal bleeding is subject to debate. A randomized comparison between the 2 treatments was performed in candidates for liver transplantation (LT). A total of 62 patients with Child-Turcotte-Pugh B-C cirrhosis and high risk varices received propranolol (31) or variceal banding (31). The primary endpoint was variceal bleeding. There were 2 variceal hemorrhages (6.5%) in the banding group, related to postbanding ulcers, and 3 (9.7%) in the propranolol group (P = not significant [n.s.]). Deaths and bleeding related deaths were 3 and 1 for banding and 3 and 2 for BB, respectively (P = n.s.). A total of 14 patients underwent LT in the banding group and 10 in the propranolol group (P = n.s.). Adverse events were 2 postbanding ulcer bleedings in ligated patients (1 fatal) and 5 were intolerant to propranolol (P = n.s.). Mean costs per patient were higher with banding than with propranolol treatment (4,289 +/- 285 vs. 1,425 +/- 460 U.S. dollars, P < 0.001). In conclusion, propranolol and banding are similarly effective in reducing the incidence of variceal bleeding in candidates for LT, but ligation can be complicated by fatal bleeding and is more expensive. Our results suggest that banding should not be utilized as primary prophylaxis in transplant candidates who can be treated with BB.

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    • "-0.092 (-0.053/ -0.131) Better EBL Better BB -75.00 -50.00 -25.00 0.00 25.00 50.00 75.00 Chen Sarin De De la Mora Song Lui Gheorge Drastich Schepke Lo Jutabha Thuluvath Psilopoulos Lay Abdelfattah Norberto 1998 1999 1999 2000 2000 2002 2002 2004 2004 2004 2005 2005 2005 2006 2006 2007 2/28 12/44 1/15 2/12 7/30 9/66 13/28 7/33 22/77 13/50 6/31 1/15 9/30 12/50 13/52 3/31 1/26 4/45 2/15 1/12 6/31 3/44 3/25 4/40 19/75 8/50 0/31 2/16 2/30 11/50 4/51 2/31 Odds ratio A B Pool (Fixed effect) 132/592 72/572 0.497 (0.366/0.675) Better EBL Better BB 1/64 1/16 1/4 1 4 16 64 Year BB EBL Chen Sarin De la Mora Song Lui Gheorge Drastich Schepke Lo Jutabha Thuluvath Psilopoulos Lay Abdelfattah Norberto 3/28 5/44 1/12 8/30 18/66 5/28 3/33 33/77 11/50 4/31 3/15 10/30 12/50 5/52 3/31 3/26 5/45 0/12 5/31 11/44 1/25 2/40 34/75 12/50 0/31 6/16 12/30 14/50 4/51 3/31 Odds ratio Pool (Fixed effect) 124/577 112/557 0.934 (0.692/1.262) "
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