OC53 Safety and efficacy of carvedilol in children with portal hypertension: a single-centre retrospective study

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Carvedilol, a non-selective beta-blocker widely used in adult portal hypertension (PHN) 1, has limited evidence for its efficacy in paediatrics. This retrospective cross-sectional study from a paediatric liver centre in the United Kingdom evaluated Carvedilol’s tolerability and efficacy in managing paediatric PHN. All children who commenced Carvedilol for PHN were identified from the Liver unit data base. Those with minimum follow up of one year post Carvedilol were included. Post Transplant and three other patients were excluded: two due to adverse events (dizziness and hallucinations in the first week of commencing Carvedilol) and one for non-adherence. Demographics, laboratory data, diagnosis, Fibro scans, shunt surgery, frequency of endoscopy and need for intervention (banding and /or sclerotherapy) were obtained from medical records. All children were on endoscopic surveillance and had required intervention (banding and/or sclerotherapy )before starting Carvedilol. Screening before commencing Carvedilol, dose of Carvedilol and frequency of endoscopy was as per the unit protocol. As shown in table 1, the final cohort included 36 children on Carvedilol, (20 males, 16 females) with a median age of 10 years (range 1–16). 20 children had cirrhotic portal hypertension (CPHN) and 16 non-cirrhotic portal hypertension (NCPHN). The median duration of endoscopic surveillance before and after starting Carvedilol was 4.38 (0.28–9.26) and 1.1(0.38–3.32) years in the NCPHN group, and 2.31(0.24–9.58) years and 1.5(0.23–2.7) years in the CPHN group respectively. Fibro scan readings were available in 16 patients (8 in each group) before starting Carvedilol, with median values of 20 (7.4–48.2) kPa in CPHN and 6.16 (2.7–10.2) kPa in NCPHN groups. Breakthrough bleeding was noted in 3 out of 16 patients in the NCPHN group compared to 2 of 20 patients in the CPHN group post Carvedilol. A significant reduction in endoscopic interventions in the CPHN group (p=0.011) following carvedilol therapy was noted. Of the patients with break through bleeding, 1 patient in the NCPHN group required liver transplantation and 2 had shunt surgery. Both patients with break through bleeding in the CPHN group had unsuccessful Trans jugular intrahepatic portosystemic shunt placement. One remains well on Carvedilol and the other had embolization of gastric varix. The study has several limitations: missing data points, small sample size and a short follow-up after Carvedilol initiation. Despite these limitations, the findings demonstrated good medication tolerability and promising results in reducing endoscopic interventions in the CPHN group. The authors suggest longer follow-up studies to establish Carvedilol’s efficacy in paediatric PHN management. Reference Tripathi D, Ferguson JW, Kochar N, et al. Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed. Hepatology 2009;50(3):825–33.

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