Background: Esophago-gastric varices are abnormal distended veins usually seen in the esophagus (esophageal varices) and less commonly in the stomach (gastric varices) or in other sites (ectopic varices), bleeding such varices prior to liver transplantation may increase the MELD associated – co-morbidities and even mortalities, hence Liver operation may cancelled in different situations, Nevertheless (VBL) should be optimized critically to improve overall success. Aim: Evaluated prophylactic (VBL) may have a beneficial role improving MELD score for those awaiting for Liver Transplantation.

Methods: prospectively 70 patients; 53 male and 17 female awaiting for liver transplantation aged (18 to 63) year - old (MELD score ranged between 16 to 38), presented with esophageal/gastric varices with different grades, VBL was done as primary prophylaxis and comparative MELD score was calculated at the time of VBL and 2 weeks further on. Children was excluded from the study, additionally patients beyond Milan HCC criteria and those with contraindication for major surgery were excluded also.

Results: MELD score improved post VBL without reported complications, additionally VBL as a primary prophylaxis was a corner stone procedure saving those with large varices against bleeding may affect the overall operation prognosis, Mean, Median and SD before and after VBL was; (18.9,19.2, 6.02) and (16.9,15.9,6.5) respectively.

Conclusion: Cirrhotic patients presented with large esophageal varices (LEVs) prepared for liver transplantation should receive variceal band ligation (VBL) prior to surgery, should decrease associated co-morbidities. MELD score have been improved totally post (VBL), but statistically showed no significant importance.