BACKGROUND Recent evidence cautions against the use of non-selective beta-blockers (NSBB) in patients with refractory ascites or spontaneous bacterial peritonitis while other data suggests a survival benefit in patients with advanced liver disease. The aim of this study was to describe the use and impact of NSBB in patients with cirrhosis referred for liver transplantation. METHODS A single-center cohort of patients with cirrhosis, who were referred and evaluated for liver transplantation between January and June 2012 were studied for baseline characteristics and clinical outcomes. Patients were grouped according to the use of NSBB at initial evaluation, with the endpoint of 90-day mortality. RESULTS Sixty-five (38%) of 170 consecutive patients evaluated for liver transplantation were taking NSBB. Patients taking NSBB had higher MELD and Child Pugh score. NSBB use was associated with lower 90-day mortality (6% vs. 15%) with a risk adjusted hazard ratio of 0.27 (95%CI .09-0.88, p = .03). Patients taking NSBB developed acute kidney injury (AKI) within 90 days more frequently than patients not taking NSBB (22% vs 11%), p = 0.048). However, this was related to increased stage 1 AKI episodes, all of which resolved. Twelve (27%) of 45 patients with > 90 day follow up discontinued NSBB, most commonly for hypotension and AKI, had increased subsequent MELD and mortality. CONCLUSIONS NSBB use in patients with cirrhosis undergoing liver transplant evaluation is associated with better short-term survival. Nevertheless, ongoing tolerance of NSBB in this population is dynamic and may select a subset of patients with better hemodynamic reserve.

中文翻译：

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非选择性β受体阻滞剂的使用与肝移植患者肝硬化患者的短期生存率提高有关。

背景技术最近的证据警告不要在顽固性腹水或自发性细菌性腹膜炎患者中使用非选择性β受体阻滞剂（NSBB），而其他数据则表明在晚期肝病患者中可以生存。这项研究的目的是描述NSBB在肝移植患者肝硬化患者中的使用和影响。方法研究2012年1月至2012年6月间接受肝移植评估的单中心肝硬化患者的基线特征和临床结局。根据初次评估时使用NSBB对患者分组，终点为90天死亡率。结果170例接受肝移植的连续患者中有65例（38％）正在服用NSBB。服用NSBB的患者的MELD和Child Pugh评分较高。使用NSBB可以降低90天死亡率（6％比15％），风险调整后的危险比为0.27（95％CI .09-0.88，p = .03）。与未服用NSBB的患者相比，服用NSBB的患者在90天内更容易出现急性肾损伤（AKI）（22％vs 11％，p = 0.048）。但是，这与1期AKI发作增加有关，所有这些都已解决。45例接受90天以上随访的患者中有12例（27％）中断了NSBB，最常见的原因是低血压和AKI，随后的MELD和死亡率增加。结论在接受肝移植评估的肝硬化患者中使用NSBB与更好的短期生存率相关。然而，该人群对NSBB的持续耐受是动态的，可以选择血液动力学储备更好的患者亚组。