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

B. Shneider Xiao-Tian Gao Ke-Xin Guo Catalina Jaramillo Jean P. Molleston J. Pimenta Riccardo Superina A. Ferreira Alexis J. Gumm A. Aqul Amy G. Feldman A. Di Giorgio A. Pai Anja Praprotnik Novak Antoine Gardin Carolina Jimenez Rivera C. U. Amaro-Reynoso Chaitri Desai D. Voroniak Denise Aldrian E. Bannister Eyal Shteyer G. Vogel G. Indolfi H. V. D. van der Doef J. Squires J. Hartley J. Gana Jesús Quintero Bernabeu Jordache Taylor Katherine F. Sweeny Kee S. Chew K. Hazleton Lee M. Bass María Mercadal Hally M. Durilová M. Homan Mercedes Martinez M. Kehar M. Kasahara O. Godik Orit Waisbourd-Zinman P. Valentino P. Spector R. Fawaz R. Vázquez-Frias Rustam Yuldashev Ryuji Komine Sakil Kulkarni Samar H. Ibrahim Sarah M. Bedoyan S. Smith S. Elisofon Simon Lam S. Yokoyama Simona Carrera Songpon Getsuwan Suporn Treepongkaruna S. Berkenfeld Thomai Kotsou Deborah A. Goldman V. Slowik Way S. Lee W. Karnsakul W. Hardikar Yael Mozer-Glassberg R. de Franchis Oanez Ackermann T. Grammatikopoulos

Oct 2026 · Hepatology · 0 citations

Medicine

Abstract

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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