Long-term outcome after endoscopic ligation of acute esophageal variceal bleeding in patients with liver cirrhosis.

Endoscopic variceal ligation (EVL) has been the standard treatment for acute variceal bleeding (AVB). However, reports of long-term prognosis after EVL are scarce. Therefore, the current work aimed to investigate the long-term outcome and prognostic modifiers of cirrhotic cases presented with acute esophageal variceal bleeding and managed with EVL. The current prospective work comprised primarily 276 consecutive grown-up cirrhotic cases presenting with AVB and managed with EVL. Two-hundred patients who completed the study till death or 3-year follow-up were enrolled in final analysis. The primary outcome measure was occurrence of rebleeding and all-cause mortality. By the end of follow up 56 patients (28%) developed rebleeding and 78 (39%) died. The independent factors associated with rebleeding were lacking follow up EVL (OR: 4.8, 95%CI: 1.9-12.2), BMI > 30 kg/m2 (OR: 0.-, 95%CI: 0.2-0.9), Child class C (OR: 3.8, 95%CI: 1.8-7.8), and grade IV varices (OR: 2.6, 95%CI: 1.3-5.3). The independent factors associated with mortality were: Age > 65 years (OR: 32.4, 95%CI: 8.7-120.3), rebleeding (OR: 98.4, 95%CI: 27.9-347.0), coexistence of HCC (OR: 7.4, 95%CI: 2.0-27.4), and lacking follow up EVL (OR: 6.1, 95%CI: 1.2-31.1). Recurrent bleeding after emergency endoscopic ligation of acute esophageal variceal bleeding in cirrhotic cases is a rather common complication that significantly increases the mortality rate. The liver condition, lack of follow up endoscopy, old age, and severity of esophageal varices are independent prognostic indicator of rebleeding and morality.

Donor related risk factors on the outcome of living donor liver transplantation

Background & objective: Liver transplantation is an established, effective treatment for acute and chronic end stage liver disease. Donors risk factors should be studied in order not to compromise the procedure of transplantation or to lose candidates for transplantation, the study aims to evaluate the effect of variable donor risk factors on the outcome of Living donor liver Transplantation regarding the morbidity and mortaly .Methods: the current study conducted on 48 patients who underwent living donor liver transplantation for End stage liver disease caused by chronic HCV. Morbidity and mortality were assessed at three and twelve months. Obtained data were studied in correlation with various donor related risk factors, a score designed to collect these risk factors, correlate them with recipient mortality, and graft rejection.Results: high rates of graft rejection and recipient mortality was significantly related to older donor age, donor obesity, donorrecipient gender mismatch, hepatic steatosis, and donor graft recipient weight ratio (GRWR) ≤ 0.8. The designed donor risk score of ≥ 7 was expectedly to associate with poor outcome & recipient mortality.Conclusion: The present study suggested that donor risk score can be a strong predictor of donor related risk factors and its effect on the outcome of Living Donor Liver Transplantation in patients espicially with hepatitis C genotype 4