Why GIVE a Liver Transplant to Patient with GAVE 为什么要给病人做肝移植手术.pptVIP

Why GIVE a Liver Transplant to Patients with GAVE Syndrome GAVE Gastric Antral Vascular Ectasia Incidence and Etiology More common in females (ratio reversed in cirrhotic population) Elderly-70’s 30% of patients diagnosed also have cirrhosis Other 70% associated with autoimmune diseases 5.7% of all sclerosis patients Etiology commonly thought to be related to abnormal antral motility and mucosal atrophy GAVE vs PHG Diagnosis and Symptoms GAVE lesions are restricted to antrum, diffuse or linear chronic significant blood loss often resulting in transfusion dependency Only 4% of acute GI bleeds are attributable to GAVE syndrome Portal Hypertensive Gastropathy (PHG) lesions throughout, lesions are diffuse Treatment PHG- responds to portal pressure reduction efforts Beta-blocker TIPS-Transjugular Intrahepatic Portosystemic Shunt GAVE Estrogen-Progesterone Endoscopic Argon Plasma Coagulation (APC) Antrectomy- high mortality in cirrhotic patients Liver Transplant Liver Transplant for GAVE Study out of Mayo Clinic in Jacksonville FL reviewed 597 patients transplanted from February 1998 to June 2003. 345 had EGD prior to OLT, 8 (2.3%) had GAVE pre OLT 3 of 8 had post OLT EGD, GAVE absent in all 3, other 5 had no post OLT gastrointestinal bleeding J Clin Gatroenterol. 2004. Ward EM et al Patient Demographics 49 y/o F Cirrhosis secondary to NASH (Non-alcoholic steatohepatitis Portal hypertension Hepatic Encephalopathy GAVE syndrome Clinical Data Labs Total Bilirubin 0.9-2.0 INR 1.4-1.8 Creatinine 1.2-2.4 Albumin 2.9 Sodium 130’s Platelets 40’s Hemoglobin 6.0-9.5 Interventions H/H checks 2x/week, scheduled outpatient transfusions PRBCs greater than 60 Units over 8 months APC- 7 treatments 29 Hospitalizations in 1 years time-10 for GIB/anemia UNOS MELD exception request MELD 15-25 Higher MELDs driven by AKI/HRS MELD exception request denied for: No increased mortality Try APC Recommend live liver donor Not appropriate diagnosis for MELD exception Patient Update Patient rec