Portal Hypertension and Liver Transplantation: Current Situation in Japan and Overseas
Liver transplantation is the only curative treatment option for both portal hypertension and end-stage liver disease (ESLD). In Japan, 50–60 deceased-donor liver transplant (DDLTs) and 400–500 living-donor liver transplant (LDLTs) are performed per year. Spain is the most DDLT-active country, and South Korea is the most LDLT-active country, performing 52 times as many and 5 times as many liver transplants per capita than Japan, respectively. Managing portal hypertension, ascites, hepatorenal syndrome, and spontaneous bacterial peritonitis is the key for bridging the interim period in patients waiting for liver transplantation. The Baveno VI consensus workshop recommendation is an important strategy for portal hypertension patients. International ascites club guidelines are other crucial strategies for ESLD patients. For a successful liver transplantation, multidisciplinary approach is essential to manage patients during both pre- and posttransplant periods. Regarding post-liver transplant patients, although liver transplantation resolves portal hypertension, a small-for-size graft in LDLT, acute rejection, and recurrence of the original liver disease may lead to newly developing or recurring portal hypertension. Further studies are needed to develop a management strategy for portal hypertension in pre- and post-liver transplant patients.
KeywordsBaveno VI consensus International ascites club guideline Deceased-donor Living-donor Liver transplantation
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