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Non-selective β-blockers are associated with improved survival in patients with ascites listed for liver transplantation
  1. Joanna A Leithead1,2,
  2. Neil Rajoriya1,
  3. Nadeem Tehami1,
  4. James Hodson3,
  5. Bridget K Gunson1,2,
  6. Dhiraj Tripathi1,
  7. James W Ferguson1
  1. 1Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
  2. 2NIHR Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK
  3. 3Department of Statistics, Wolfson Building, Queen Elizabeth Hospital, Birmingham, UK
  1. Correspondence to Dr Joanna Agnes Leithead, Clinical Lecturer in Hepatology, Centre for Liver Research, NIHR Biomedical Research Unit, Institute of Biomedical Research (5th floor), University of Birmingham, Edgbaston, Birmingham B15 2TT UK; j.a.leithead{at}bham.ac.uk

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.

  • LIVER TRANSPLANTATION
  • ASCITES

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