Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2020; 12(11): 1067-1075
Published online Nov 27, 2020. doi: 10.4254/wjh.v12.i11.1067
Outcome of gastric antral vascular ectasia and related anemia after orthotopic liver transplantation
Saad Emhmed Ali, Karim M Benrajab, Anna Christina Dela Cruz
Saad Emhmed Ali, Division of Hospital Medicine, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40536, United States
Karim M Benrajab, Anna Christina Dela Cruz, Division of Digestive Diseases and Nutrition, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40536, United States
Author contributions: Emhmed Ali S and Dela Cruz AC provided the conception and designed the study; Emhmed Ali S, Benrajab K and Dela Cruz AC analyzed and interpreted the data and wrote the manuscript; all authors have read and approved the final manuscript. 
Institutional review board statement: The study was reviewed and approved by the University of Kentucky Institutional Review Board (Approval No 54669).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: Authors have no relevant relationships or conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Karim M Benrajab, MD, Assistant Professor, Division of Digestive Diseases and Nutrition, Department of Internal Medicine, University of Kentucky College of Medicine, 800 Rose Street, MN649, Lexington, KY 40536, United States. karimbenrajab@gmail.com
Received: July 27, 2020
Peer-review started: July 27, 2020
First decision: September 21, 2020
Revised: October 4, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: November 27, 2020
Abstract
BACKGROUND

Gastric antral vascular ectasia (GAVE) is a significant complication of cirrhosis. Numerous medical, surgical, and endoscopic treatment modalities have been proposed with varied satisfactory results. In a few small studies, GAVE and associated anemia have resolved after orthotopic liver transplantation (OLT). 

AIM

To assess the impact of OLT on the resolution of GAVE and related anemia.

METHODS

We retrospectively reviewed clinical records of adult patients with GAVE who underwent OLT between September 2012 and September 2019. Demographics and other relevant clinical findings were collected, including hemoglobin levels and upper endoscopy findings before and after OLT. The primary outcome was the resolution of GAVE and its related anemia after OLT.

RESULTS

Sixteen patients were identified. Mean pre-OLT Hgb was 7.7 g/dL and mean 12 mo post-OLT Hgb was 11.9 g/dL, (P = 0.001). Anemia improved (defined as Hgb increased by 2g) in 87.5% of patients within 6 to 12 mo after OLT and resolved completely in half of the patients. Post-OLT esophagogastroduodenoscopy was performed in 10 patients, and GAVE was found to have resolved entirely in 6 of those patients (60%). 

CONCLUSION

Although GAVE and associated anemia completely resolved in the majority of our patients after OLT, GAVE persisted in a few patients after transplant. Further studies in a large group of patients are necessary to understand the causality of disease and to better understand the factors associated with the persistence of GAVE post-transplant.

Keywords: Liver cirrhosis, Iron deficiency anemia, End-stage liver disease, Gastroscopy, Gastrointestinal hemorrhage, Liver transplantation

Core Tip: In this retrospective study, cirrhotic patients who had gastric antral vascular ectasia (GAVE) with anemia and underwent orthotopic liver transplant (OLT) between September 2012 and September 2019 were reviewed to evaluate the impact of OLT on resolution of GAVE and associated anemia. A total of 296 patients underwent OLT during the study period; sixteen patients had GAVE. Anemia improved in the majority of patients in 6 to 12 mo post-OLT, and of the 10 patients who had a post-OLT esophagogastroduodenoscopy, GAVE was found to have completely resolved in 6 of those patients. We concluded that GAVE and associated anemia completely resolved in the majority of our patients post-OLT.