An international multicenter analysis of the outcome of pediatric first variceal hemorrhage

Shneider BL 1 , Gao X 1 , Guo K 1 , Jaramillo C 2 , Molleston JP 3 , Pimenta J 4 Show all authors , Superina R 5 , Ferreira A 4 , Gumm AJ 6 , Aqul A 7 , Feldman AG 8 , Di Giorgio A 9 , Pai AK 10 , Novak AP 11 , Gardin A 12 , Jimenez-Rivera C 13 , Amaro-Reynoso CU 14 , Desai C 15 , Voroniak D 16 , Aldrian D 17 , Bannister E 18 , Shteyer E 19 , Vogel GF 17 , Indolfi G 20 , van der Doef HPJ 21 , Squires JE 22 , Hartley JL 23 , Gana JC 24 , Quintero-Bernabéu J 25 , Taylor J 26 , Sweeny K 27 , Chew KS 28 , Hazleton KZ 29 , Bass LM 5 , Mercadal-Hally M 25 , Durilova M 30 , Homan M 11 , Martinez M 31 , Kehar M 13 , Kasahara M 32 , Godik O 16 , Waisbourd-Zinman O 33 , Valentino PL 34 , Spector PR 31 , Fawaz R 35 , Vázquez-Frias R 14 , Yuldashev R 36 , Komine R 32 , Kulkarni S 37 , Ibrahim SH 38 , Bedoyan S 22 , Smith SK 39 , Elisofon SA 27 , Lam S 40 , Yokoyama S 41 , Carrera S 20 , Getsuwan S 42 , Treepongkaruna S 42 , Berkenfeld S 43 , Kotsou T 21 , Goldman D 44 , Slowik V 15 , Lee WS 28 , Karnsakul W 39 , Hardikar W 18 , Mozer-Glassberg Y 33 , De Franchis R 45 , Ackermann O 12 , Grammatikopoulos T 26

Affiliations 

  • 1 Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
  • 2 Department of Pediatrics, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah, USA
  • 3 Department of Pediatrics, Indiana University School of Medicine/Riley Hospital for Children, Indianapolis, Indiana, USA
  • 4 Hospital das Clínicas, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
  • 5 Lurie Children's Hospital and Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
  • 6 Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
  • 7 Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Southwestern Medical Center in Dallas and Dallas Children's Health, Dallas, Texas, USA
  • 8 Section of Pediatric GI, Hepatology and Nutrition, Digestive Health Institute, University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora, Colorado, USA
  • 9 Pediatric Hepatology and Transplantation, ASST Hospital Papa Giovanni XXIII, Bergamo, University of Udine, Udine, Italy
  • 10 Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  • 11 Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia
  • 12 Hépatologie et Transplantation hépatique pédiatriques, Hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin-Bicêtre, INSERM U1193, Orsay, France
  • 13 Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada
  • 14 Research Office, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
  • 15 Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, USA
  • 16 National Children's Specialized Hospital "Okhmatdyt," Kyiv, Ukraine
  • 17 Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
  • 18 Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia
  • 19 The Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Jerusalem, Israel
  • 20 Meyer Children's Hospital, IRCCS, Florence, Italy
  • 21 Division of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, University Medical Centre Groningen, Groningen, The Netherlands
  • 22 Department of Pediatric Gastroenterology and Hepatology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
  • 23 Birmingham Women's and Children's Hospital, Birmingham, UK
  • 24 Department of Pediatric Gastroenterology and Nutrition, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
  • 25 Paediatric Hepatology and Liver Transplantation Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  • 26 Paediatric Liver, GI and Nutrition Centre, King's College Hospital NHS Trust and The Roger Williams Institute of Liver Studies, School of Immunology & Microbial Sciences, King's College, London, UK
  • 27 Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
  • 28 Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
  • 29 Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, California, USA
  • 30 Department of Paediatrics, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
  • 31 Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, New York, USA
  • 32 Organ Transplant Center, National Center for Child Health and Development, Tokyo, Japan
  • 33 Pediatric Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Gray Faculty of Medical Health and Sciences, Tel Aviv University, Tel Aviv, Israel
  • 34 Division of Gastroenterology and Hepatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
  • 35 Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
  • 36 Department of Pediatric Surgery, Republican Specialized Scientific-Practical Medical Center of Pediatrics, Tashkent, Uzbekistan
  • 37 Department of Pediatrics, Washington University in St. Louis, St. Louis, Illinois, USA
  • 38 Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
  • 39 Department of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  • 40 Division of Pediatric Gastroenterology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
  • 41 Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • 42 Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • 43 Wits Donald Gordon Medical Center, Johannesburg, South Africa
  • 44 Department of Pediatrics, Cleveland Clinic School of Medicine, Cleveland, Ohio, USA
  • 45 Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
Hepatology, 2026 Oct 07.
PMID: 42842335 DOI: 10.1097/HEP.0000000000001881

Abstract

BACKGROUND AND AIMS: Management of portal hypertension in children, including primary prophylaxis of variceal bleeding, is controversial due to limited understanding of mortality risk after the first variceal hemorrhage (1VH). This international multicenter study was designed to advance understanding of outcomes after pediatric 1VH.

APPROACH AND RESULTS: Center-specific characteristics and approaches to portal hypertension were determined at 44 international sites. K-means clustered the centers based upon volume and complexity of approaches [cluster 1 high (n=5), cluster 2 low (n=21), cluster 3 intermediate (n=18)]. Clinical features and outcomes after 1VH were available from 345 subjects. Factors associated with overall survival (OS) and survival with native liver (SNL) were estimated by Kaplan-Meier survival curves, log-rank tests, univariable and multivariable Cox regression models. OS and SNL were high in portal vein thrombosis and noncirrhotic diseases and significantly higher than biliary atresia and cirrhotic diseases ( p

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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