Non-selective beta blocker use is associated with improved short-term survival in patients with cirrhosis referred for liver transplantation.

Abstract:

BACKGROUND:Recent evidence cautions against the use of non-selective beta-blockers (NSBB) in patients with refractory ascites or spontaneous bacterial peritonitis while other data suggests a survival benefit in patients with advanced liver disease. The aim of this study was to describe the use and impact of NSBB in patients with cirrhosis referred for liver transplantation. METHODS:A single-center cohort of patients with cirrhosis, who were referred and evaluated for liver transplantation between January and June 2012 were studied for baseline characteristics and clinical outcomes. Patients were grouped according to the use of NSBB at initial evaluation, with the endpoint of 90-day mortality. RESULTS:Sixty-five (38%) of 170 consecutive patients evaluated for liver transplantation were taking NSBB. Patients taking NSBB had higher MELD and Child Pugh score. NSBB use was associated with lower 90-day mortality (6% vs. 15%) with a risk adjusted hazard ratio of 0.27 (95%CI .09-0.88, p = .03). Patients taking NSBB developed acute kidney injury (AKI) within 90 days more frequently than patients not taking NSBB (22% vs 11%), p = 0.048). However, this was related to increased stage 1 AKI episodes, all of which resolved. Twelve (27%) of 45 patients with > 90 day follow up discontinued NSBB, most commonly for hypotension and AKI, had increased subsequent MELD and mortality. CONCLUSIONS:NSBB use in patients with cirrhosis undergoing liver transplant evaluation is associated with better short-term survival. Nevertheless, ongoing tolerance of NSBB in this population is dynamic and may select a subset of patients with better hemodynamic reserve.

journal_name

BMC Gastroenterol

journal_title

BMC gastroenterology

authors

Ngwa T,Orman E,Gomez EV,Vuppalanchi R,Kubal C,Chalasani N,Ghabril M

doi

10.1186/s12876-019-1155-1

subject

Has Abstract

pub_date

2020-01-06 00:00:00

pages

4

issue

1

issn

1471-230X

pii

10.1186/s12876-019-1155-1

journal_volume

20

pub_type

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