Why GIVE a Liver
Transplant to Patients
with GAVE Syndrome
GAVE
Gastric Antral Vascular Ectasia
Incidence and Etiology
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More common in females (ratio reversed in
cirrhotic population)
Elderly-70’s
30% of patients diagnosed also have cirrhosis
Other 70% associated with autoimmune
diseases
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5.7% of all sclerosis patients
Etiology commonly thought to be related to
abnormal antral motility and mucosal atrophy
GAVE vs PHG
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Diagnosis and Symptoms
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GAVE
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lesions are restricted to antrum, diffuse or linear
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chronic significant blood loss often resulting in transfusion dependency
Only 4% of acute GI bleeds are attributable to GAVE syndrome
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Portal Hypertensive Gastropathy (PHG)
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lesions throughout, lesions are diffuse
Treatment
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PHG- responds to portal pressure reduction efforts
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Beta-blocker
TIPS-Transjugular Intrahepatic Portosystemic Shunt
GAVE
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Estrogen-Progesterone
Endoscopic Argon Plasma Coagulation (APC)
Antrectomy- high mortality in cirrhotic patients
Liver Transplant
Liver Transplant for GAVE
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Study out of Mayo Clinic in Jacksonville FL
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reviewed 597 patients transplanted from February
1998 to June 2003.
345 had EGD prior to OLT, 8 (2.3%) had GAVE
pre OLT
3 of 8 had post OLT EGD, GAVE absent in all 3,
other 5 had no post OLT gastrointestinal bleeding
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J Clin Gatroenterol. 2004. Ward EM et al
Patient Demographics
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49 y/o F
Cirrhosis secondary to NASH (Non-alcoholic
steatohepatitis
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Portal hypertension
Hepatic Encephalopathy
GAVE syndrome
Clinical Data
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Labs
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Total Bilirubin 0.9-2.0
INR 1.4-1.8
Creatinine 1.2-2.4
Albumin 2.9
Sodium 130’s
Platelets 40’s
Hemoglobin 6.0-9.5
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Interventions
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H/H checks 2x/week,
scheduled outpatient
transfusions
PRBCs greater than 60
Units over 8 months
APC- 7 treatments
29 Hospitalizations in 1
years time-10 for
GIB/anemia
UNOS MELD exception request
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MELD 15-25
Higher MELDs driven by AKI/HRS
MELD exception request denied for:
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No increased mortality
Try APC
Recommend live liver donor
Not appropriate diagnosis for MELD exception
Patient Update
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Patient recently transplanted
Post OLT course has been quite complicated
but no gastrointestinal bleeding
Has not had EGD post OLT to confirm
resolution
Nursing Implications
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Correct diagnosis is key for treatment
Educating the patient and other care givers
about GAVE syndrome
Scheduling of serial H/H checks, transfusions,
Endoscopic APC
Resolves with Liver Transplantation though
exact mechanism is unknown