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Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Gut
  2015/07  
 
  2015 Jul;64(7):1111-9  
  doi:10.1136/gutjnl-2013-306502  
 
  Non-selective β-blockers are associated with improved survival in patients with ascites listed for liver transplantation  
 
  Leithead JA, Rajoriya N, Tehami N, Hodson J, Gunson BK, Tripathi D, Ferguson JW.  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Non-selective+%CE%B2-blockers+are+associated+with+improved+survival+in+patients+with+ascites+listed+for+liver+transplantation  
 
 

Abstract

Objective Recent data have suggested that non-selective β-blockers (NSBB) are associated with increased mortality in patients with cirrhosis and refractory ascites. However, other evidence implies that NSBB may be beneficial in this setting by reducing bacterial translocation. Our aim was to determine whether NSBB use was a risk factor for mortality in patients with end-stage chronic liver disease and ascites awaiting liver transplantation.

Design This was a single-centre retrospective study of 322 patients with ascites listed January 2007 to July 2011.

Results NSBB patients (n=159) and non-NSBB patients (n=163) were comparable with regards to listing model for end-stage liver disease score (p=0.168), frequency of hepatocellular carcinoma (p=0.193) and refractory ascites (35.2% vs. 37.4%, p=0.681). 82 patients died, 221 patients were transplanted and 19 patients were removed from the list during a median follow-up duration of 72 days; the median time to death was 150 and 54 days in the NSBB and non-NSBB groups, respectively. In a multivariate competing risk Cox model, patients on NSBB had reduced mortality compared with propensity risk score-matched non-NSBB patients (HR 0.55; 95% CI 0.32 to 0.95, p=0.032). Similarly, in the subgroup of patients with refractory ascites (n=117), NSBB remained independently associated with less waitlist death (adjusted HR 0.35; 95% CI 0.14 to 0.86, p=0.022).

Conclusions NSBB in patients with ascites and refractory ascites listed for liver transplantation are not detrimental, and instead are associated with reduced waitlist death. Our findings argue that NSBB are safe and may confer benefit in patients with ascites complicating end-stage liver disease.

 

 
Question posée
 
Un rôle délétère des béta-bloquants non cardio-sélectifs (BBNCS) a été suggéré avec augmentation de la mortalité chez les patients cirrhotiques avec ascite réfractaire : qu’en-est-il chez les patients cirrhotiques ascitiques inscrits sur liste de transplantation hépatique ?
 
Question posée
 
Ces patients ayant une cirrhose sévère (MELD médian à 17) inscrit sur liste de transplantation hépatique et traités par BBNCS ont une diminution de mortalité et meurt moins « sur liste » comparés à ceux ne recevant pas de BBNCS.
 
Commentaires

Ces patients cirrhotiques bien sélectionnés âgés de moins de 60 ans avec certainement moins de co-facteurs cardio-vasculaires, inscrits sur liste de transplantation hépatique ont un bénéfice à être traités par BBNCS que ce soit le propranolol ou le carvédilol.

 

 
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