Lorenzo Norberto and Lino Polese contributed equally to this work.
A randomized study comparing ligation with propranolol for primary prophylaxis of variceal bleeding in candidates for liver transplantation
Article first published online: 16 MAR 2007
Copyright © 2007 American Association for the Study of Liver Diseases
Volume 13, Issue 9, pages 1272–1278, September 2007
How to Cite
Norberto, L., Polese, L., Cillo, U., Grigoletto, F., Burroughs, A. K., Neri, D., Zanus, G., Boccagni, P., Burra, P. and D'Amico, D. F. (2007), A randomized study comparing ligation with propranolol for primary prophylaxis of variceal bleeding in candidates for liver transplantation. Liver Transpl, 13: 1272–1278. doi: 10.1002/lt.21083
- Issue published online: 30 AUG 2007
- Article first published online: 16 MAR 2007
- Manuscript Accepted: 25 NOV 2006
- Manuscript Received: 14 SEP 2006
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. Liver Transpl, 2007. © 2007 AASLD.