Potential conflict of interest: Nothing to report.
Liver Failure/Cirrhosis/Portal Hypertension
Article first published online: 6 JUL 2012
Copyright © 2012 American Association for the Study of Liver Diseases
Volume 56, Issue 2, pages 706–714, August 2012
How to Cite
Augustin, S., González, A., Badia, L., Millán, L., Gelabert, A., Romero, A., Segarra, A., Martell, M., Esteban, R., Guardia, J. and Genescà, J. (2012), Long-term follow-up of hemodynamic responders to pharmacological therapy after variceal bleeding. Hepatology, 56: 706–714. doi: 10.1002/hep.25686
Salvador Augustin is a recipient of a Río Hortega fellowship grant from the Instituto de Salud Carlos III and a Juan Rodés grant from the Asociación Española para el Estudio del Hígado. The study was partially funded by grant SAF2009-08354 from Ministerio de Ciencia e Innovación. CIBERehd is supported by Instituto de Salud Carlos III.
- Issue published online: 25 JUL 2012
- Article first published online: 6 JUL 2012
- Accepted manuscript online: 1 MAR 2012 07:00AM EST
- Manuscript Accepted: 13 FEB 2012
- Manuscript Received: 30 SEP 2011
Although it is assumed that hemodynamic responders to pharmacological therapy after a variceal hemorrhage are adequately protected from rebleeding, there is no evidence that either this response or its protective effect extend beyond the usual 2-year follow-up featured in available studies. We aimed to assess the maintenance of hemodynamic response and its impact on outcomes in a large cohort of hemodynamic responders during a long follow-up. One hundred three patients with cirrhosis admitted with acute variceal bleeding between 2001 and 2010 were prospectively evaluated. The hepatic venous pressure gradient (HVPG) was determined 5 days after the bleeding and repeated 5-7 days after maximal tolerated doses of nadolol and nitrates. Hemodynamic responders (HVPG ≤12 mm Hg or ≥20% decrease from baseline) were maintained on drugs and followed up with annual HVPG measurements. Forty-eight patients (47%) were hemodynamic responders. The median follow-up was 48 months (range, 2-108 months). Long-term HVPG evaluations could not be performed in eight patients (four deaths, two rebleedings, two follow-ups <1 year). Among the remaining 40 patients, hemodynamic response was maintained in 26 (65%) and lost in 14 (35%). There were no baseline differences between the two subgroups. However, 100% of alcoholic patients who remained abstinent maintained long-term response, compared with 36% of nonabstinent alcoholics and 50% of patients with viral cirrhosis. Patients with loss of hemodynamic response rebled more during follow-up and showed a higher incidence of death or liver transplantation. Conclusions: After variceal bleeding, long-term maintenance of hemodynamic response to drug therapy is mainly restricted to patients with alcoholic cirrhosis who remain abstinent. The loss of this long-term response carries worse clinical outcomes. (HEPATOLOGY 2012)