PURPOSE: Non-selective beta-adrenergic blocking agents have been shown to decrease hepatic venous gradient and reduce the formation of esophageal varices in patients with cirrhosis. However, the role of beta-blockade in hepatopulmonary syndrome (HPS) has not been well-studied. The objective of this study is to demonstrate the potential benefit of non-selective beta-adrenergic blocking agents and the occurrence of the HPS among orthotopic liver transplant candidates.
METHODS: We conducted a cross-sectional study reviewing 121 consecutive patients with liver cirrhosis who were candidates for liver transplantation admitted to an academic teaching hospital from the 2008 to 2010. Patients who used beta-blocker for more than two consecutive admissions were relegated to the user group. Patients who had other causes of hypoxia were excluded.
RESULTS: The overall occurrence of HPS was 15% (18/121). Multivariate regression analysis, adjusted for demographic data and Model for End-Stage Liver Disease (MELD) score, demonstrated that beta-blocker use was not significantly associated with HPS. (OR 0.67, p=0.42, CI 0.26-1.8). In adjusted analysis, high MELD score (≥15) approached significant association with the occurrence of HPS (OR 1.06, p=0.09, CI 0.99-1.14). The severity of HPS as measured by degree of hypoxemia did not differ between the two groups.
CONCLUSIONS: The use of non-selective beta-blockers is not associated with a reduction in the occurrence of HPS. Our small sample size may limit the power of statistical analysis to demonstrate the benefit of beta-blocker on HPS in cirrhosis patients.
CLINICAL IMPLICATIONS: Non-selective beta-blockers use is not associated with a reduction in the occurrence of HPS in liver transplant candidates. High MELD score may be related to the occurrence of HPS.
DISCLOSURE: The following authors have nothing to disclose: Danai Khemasuwan, Krittika Teerapuncharoen, Murali Krishna Chelikani, Jeong Yun, Glenn Eiger
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