An international multicenter analysis of the outcome of pediatric first variceal hemorrhage
Benjamin L. ShneiderTexas Children's HospitalXiaotian GaoTexas Children's HospitalKexin GuoDepartment of Pediatrics, Baylor College of Medicine and Texas Children’s HospitalCatalina JaramilloDepartment of Pediatrics, University of Utah School of Medicine and Primary Children’s Hospital, Salt Lake City, Utah, USAJean Pappas MollestonDepartment of Pediatrics, Indiana University School of Medicine/Riley Hospital for Children, Indianapolis, IN, USAJulio PimentaHospital das Clínicas, Federal University of Minas Gerais (UFMG), BrazilRiccardo SuperinaLurie Children’s Hospital and Feinberg School of Medicine, Northwestern University, Chicago, IL, USAAlexandre FerreiraHospital das Clínicas, Federal University of Minas Gerais (UFMG), BrazilAlexis J. GummDepartment of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Wisconsin, Milwaukee WI, USAAmal AqulDepartment of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition University of Texas Southwestern Medical Center in Dallas and Dallas Children’s Health, Dallas TX, USAAmy G. FeldmanUniversity of Colorado DenverAngelo Di GiorgioPediatric Hepatology and Transplantation, ASST Hospital Papa Giovanni XXIII, Bergamo, University of Udine, Udine, ItalyAnita K. PaiDepartment of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical CenterAnja Praprotnik NovakDepartment of Gastroenterology, Hepatology and Nutrition, University Children’s Hospital Ljubljana, SloveniaAntoine GardinHépatologie et Transplantation hépatique pédiatriques, Hôpital Bicêtre, Assistance publique - hôpitaux de Paris, Université Paris-Saclay, Le Kremlin Bicêtre, INSERM U1193, Orsay, FranceCarolina Jiménez‐RiveraDivision of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, CanadaCésar Ulises Amaro-ReynosoResearch Office, Hospital Infantil de México Federico Gómez, Mexico City, MexicoChaitri DesaiDivision of Gastroenterology, Hepatology, and Nutrition, Children’s Mercy – Kansas City, Kansas City, USADariia VoroniakNational Children Specialize Hospital “Okhmatdyt” Kyiv, UkraineDenise AldrianPaediatrics I, Medical University of Innsbruck, Innsbruck, AustriaElizabeth BannisterDepartment of Gastroenterology and Clinical Nutrition, Royal Children’s Hospital, Melbourne, AustraliaEyal ShteyerThe Juliet Keidan Institute of Pediatric Gastroenterology Institute, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Jerusalem, IsraelGeorg Friedrich 1798-1836 VogelPaediatrics I, Medical University of Innsbruck, Innsbruck, AustriaGiuseppe IndolfiMeyer Children’s Hospital, IRCCS, Florence, ItalyHubert P. J. van der DoefDivision of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, University Medical Centre Groningen, Groningen, The NetherlandsJames E. SquiresDepartment of Pediatric Gastroenterology and Hepatology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA USAJane HartleyBirmingham Women’s and Children’s Hospital, Birmingham, UKJC GanaDepartment of Pediatric Gastroenterology and Nutrition, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, ChileJesús Quintero-BernabeuPaediatric Hepatology and Liver Transplantation Department, Hospital Universitari Vall d’Hebron, Barcelona, SpainJordache TaylorKing's College HospitalKatherine SweenyDivision of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USAKee-Seang ChewDepartment of Paediatrics, Faculty of Medicine, University Malaya, MalaysiaKeith Z. HazletonDepartment 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, USALee M. BassLurie Children’s Hospital and Feinberg School of Medicine, Northwestern University, Chicago, IL, USAMaria Mercadal-HallyPaediatric Hepatology and Liver Transplantation Department, Hospital Universitari Vall d’Hebron, Barcelona, SpainMarianna DurilováDepartment of Paediatrics, 2nd Faculty of Medicine and University Hospital Motol, Prague, Czech RepublicMatjaž HomanDepartment of Gastroenterology, Hepatology and Nutrition, University Children’s Hospital Ljubljana, SloveniaMercedes MartínezDepartment of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USAMohit KeharDivision of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, CanadaMureo KasaharaOrgan Transplant Center, National Center for Child Health and Development, Tokyo, JapanOleg GodikNational Children Specialize Hospital “Okhmatdyt” Kyiv, UkraineOrith Waisbourd‐ZinmanPediatric Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Gray Faculty of Medical Health and Sciences, Tel-Aviv University, Tel-Aviv, IsraelPamela L. ValentinoUniversity of WashingtonPooja Reddy SpectorDepartment of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USARima FawazDepartment of Pediatrics, Yale University School of MedicineRodrigo Vázquez-FriasResearch Office, Hospital Infantil de México Federico Gómez, Mexico City, MexicoRustam YuldashevDepartment of Pediatric Surgery, Republican Specialized Scientific-Practical Medical Center of Pediatrics, Tashkent, UzbekistanRyuji KomineOrgan Transplant Center, National Center for Child Health and Development, Tokyo, JapanKulkarni SakilDepartment of Pediatrics, Washington University in St. Louis, St. Louis, Illinois USASamar H. IbrahimDivision of Pediatric Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, USASarah BedoyanDepartment of Pediatric Gastroenterology and Hepatology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA USASara Kathryn SmithJohns Hopkins MedicineScott A. ElisofonDivision of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USASimon LamDivision of Pediatric Gastroenterology, Department of Pediatrics, University of CalgaryShinya YokoyamaDepartment of Gastroenterology and Hepatology, Nagoya University Graduate School of MedicineSimona CarreraMeyer Children’s Hospital, IRCCS, Florence, ItalySongpon GetsuwanDepartment of PediatricsSuporn TreepongkarunaDepartment of PediatricsSarah BerkenfeldWits Donald Gordon Medical CenterThomai KotsouDivision of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, University Medical Centre Groningen, Groningen, The NetherlandsDeborah GoldmanDepartment of Pediatrics, Cleveland Clinic School of Medicine, Cleveland, OH, USAVoytek SlowikDivision of Gastroenterology, Hepatology, and Nutrition, Children’s Mercy – Kansas City, Kansas City, USAWay-Seah LeeDepartment of Paediatrics, Faculty of Medicine, University Malaya, MalaysiaWikrom KarnsakulDepartment of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins University School of MedicineWinita HardikarDepartment of Gastroenterology and Clinical Nutrition, Royal Children’s Hospital, Melbourne, AustraliaYael Mozer‐GlassbergPediatric Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Gray Faculty of Medical Health and Sciences, Tel-Aviv University, Tel-Aviv, IsraelAGAF Roberto de FranchisDepartment of Biomedical and Clinical Sciences, University of Milan, Milan, ItalyOanez AckermannUniversité Paris-SaclayTassos GrammatikopoulosKing's College Hospital
2026en
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BACKGROUND AIMS: Management of portal hypertension in children including primary prophylaxis of variceal bleeding is controversial due to limited understanding of mortality risk after first variceal hemorrhage (1VH). This international multicenter study was designed to advance understanding of outcomes after pediatric 1VH. APPROACH 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<.001). Diminished SNL was observed in decompensated disease [diuretics (i.e. ascites) or hospitalization at 1VH], biliary atresia with poor bile flow, cirrhotic disease, after sclerotherapy or no endoscopic intervention. Diminished OS was noted in those with cirrhosis or requiring sclerotherapy. 6-week mortality was determined and compared among clusters using average treatment effect under the Rubin causal model. Overall 6-week mortality was 4.1%, 1.4% in nonhospitalized subjects and was significantly higher in cluster 2 versus 1 centers (P=.010). CONCLUSIONS: Immediate mortality after 1VH in children is low compared to adults. Outcomes after 1VH are diagnosis-specific and worse in decompensated disease and after sclerotherapy. Center-specific factors may influence immediate outcomes after 1VH.
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