Variceal hemorrhage is a major cause of death in cirrhotic patients despite treatment by sclerotherapy. Of our first 21 liver transplants, 8 had already suffered from variceal bleeding which was treated successfully by sclerotherapy, but 3 cirrhotic patients, eligible for orthotopic liver transplantation (OLT), had to be operated immediately after an acute episode of bleeding. Two patients underwent OLT and 1 had a portocaval H-graft shunt placed close to the liver, followed 5 weeks later by OLT. When variceal bleeding remains uncontrolled, emergency OLT is a possible alternative, provided the responsible hepatopathy is a valid indication for OLT. When no graft is available and hepatic function allows it, a portocaval H-graft shunt can be proposed since it only slightly increases the technical difficutly of a postponed OLT.

Keywords:
Variceal hemorrhage, Liver transplant candidate, Portacaval shunt
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© 1991 S. Karger AG, Basel
1991
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