Liver transplantation for variceal hemorrhage.

Orthotopic liver transplantation should be considered as a treatment for end-stage liver disease, which provides resolution to all its complications, including portal hypertensive-related bleeding. In the 1990s, variceal bleeding should be controlled primarily with endoscopy and, if this approach fails, with selective surgical shunting in those patients who have good hepatic function and with TIPS in those patients whose hepatic function is marginal and need bridging treatment until transplantation. Decompression of the portal system with either of these approaches allows for liver transplantation with challenges that can be overcome by experienced surgical teams.