1. Why GIVE a Liver Transplant to Patients with GAVE Syndrome

2. Gastric Antral Vascular Ectasia
GAVE
Gastric Antral Vascular Ectasia

3. Incidence and Etiology
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
5.7% of all sclerosis patients
Etiology commonly thought to be related to abnormal antral motility and mucosal atrophy
Gastric hypoacidity may result from presence of excessive amounts of cirulating acid-inhubity intestinal peptides, which the diseased liver fails to metabolise. Study on hypergastrinaemia in cirrhosis of liver- Gut September; 17 (9): SK Lam.

4. GAVE vs PHG Diagnosis and Symptoms Treatment GAVE
lesions are restricted to antrum, diffuse or linear
chronic significant blood loss often resulting in transfusion dependency
Only 4% of acute GI bleeds are attributable to GAVE syndrome
Portal Hypertensive Gastropathy (PHG)
lesions throughout, lesions are diffuse
Treatment
PHG- responds to portal pressure reduction efforts
Beta-blocker
TIPS-Transjugular Intrahepatic Portosystemic Shunt
Estrogen-Progesterone
Endoscopic Argon Plasma Coagulation (APC)
Antrectomy- high mortality in cirrhotic patients
Liver Transplant

5. Liver Transplant for GAVE
Study out of Mayo Clinic in Jacksonville FL
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
J Clin Gatroenterol Ward EM et al
J Clin Gastroenterol Nov-Dec, 38 (10):
Ward EM et al

6. Patient Demographics 49 y/o F
Cirrhosis secondary to NASH (Non-alcoholic steatohepatitis
Portal hypertension
Hepatic Encephalopathy
GAVE syndrome
30% of GAVE cases are associated with cirrhosis and portal hypertension

7. Clinical Data Labs Interventions Total Bilirubin 0.9-2.0 INR 1.4-1.8
Creatinine
Albumin 2.9
Sodium 130’s
Platelets 40’s
Hemoglobin
Interventions
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

8. UNOS MELD exception request
Higher MELDs driven by AKI/HRS
MELD exception request denied for:
No increased mortality
Try APC
Recommend live liver donor
Not appropriate diagnosis for MELD exception

9. Patient Update Patient recently transplanted
Post OLT course has been quite complicated but no gastrointestinal bleeding
Has not had EGD post OLT to confirm resolution

10. Nursing Implications 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