Liver transplantation for severe intrahepatic noncirrhotic portal hypertension

The noncirrhotic portal hypertension is an uncommon cause of bleeding esophagealvarices. This condition must be suspected in patients with preserved liver function. We reporta 25-year old man with SLE disease who presented with hematemesis. He had no historyor risk factors for an underlying liver condition. A huge splenomegaly was detectedby physical examination. The EGD found three large varices with red wale sign, whereas liverfunction tests were unremarkable. The noncirrhotic portal hypertension was diagnosedand confirmed by liver histopathology. Figure 1 แสดงผลการส่องกล้องทางเดินอาหารส่วนบนพบ F3 varices with red wale sign

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Risk factors and outcome of HIV-associated idiopathic noncirrhotic portal hypertension

Alimentary Pharmacology & Therapeutics ◽

10.1111/apt.12049 ◽

2012 ◽

Vol 36 (9) ◽

pp. 875-885 ◽

Cited By ~ 26

Author(s):

J. N. L. Schouten ◽

M. E. Van der Ende ◽

T. Koëter ◽

H. H. M. Rossing ◽

M. Komuta ◽

...

Keyword(s):

Risk Factors ◽

Portal Hypertension ◽

Noncirrhotic Portal Hypertension

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Hematological Indices in Portal Hypertension: Cirrhosis versus Noncirrhotic Portal Hypertension

Journal of Clinical Medicine ◽

10.3390/jcm7080196 ◽

2018 ◽

Vol 7 (8) ◽

pp. 196 ◽

Cited By ~ 1

Author(s):

Abdurrahman Sahin ◽

Hakan Artas ◽

Nurettin Tunc ◽

Mehmet Yalniz ◽

Ibrahim Bahcecioglu

Keyword(s):

Portal Hypertension ◽

Retrospective Study ◽

Radiological Findings ◽

Hematological Indices ◽

Noncirrhotic Portal Hypertension ◽

End Stage Liver Disease ◽

Cirrhotic Patients ◽

Hematological Abnormalities ◽

End Stage ◽

Cirrhotic Group

Portal hypertension (PHT) leads to several alterations on hematological indices (HI). The aim of the study is to investigate the differences in HI between cirrhotic subjects and subjects who have noncirrhotic PHT (NCPHT). This retrospective study included 328 patients with PHT (239 cirrhosis and 89 NCPHT). Demographic and clinical features, endoscopic and radiological findings, and HI including neutrophil to lymphocyte ratio (NLR) at the time of PHT diagnosis were recorded. Severity of cirrhosis was assessed according to the Child–Turcotte–Pugh (CTP) classification and Model for End-Stage Liver Disease (MELD) scores. Hematological abnormalities were found in 92.5% of cirrhotic patients and in 55.1% of patients with NCPHT (p < 0.001). While thrombocytopenia was the most common HI in patients with cirrhosis, anemia was the most prevalent HI in NCPHT group. In the cirrhotic group, the NLR was the only parameter to differentiate each CTP group from two others. The NLR value increased with the severity of cirrhosis (2.28 ± 0.14 in CTP-A, 2.85 ± 0.19 in CTP-B and 3.26 ± 0.37 in CTP-C). The AUROC of NLR was 0.692 for differentiating compensated cirrhotic patients from decompensated. Hematological abnormalities are more prevalent and more severe in cirrhotic patients compared to patients with NCPHT. NLR may be used to assess the severity of cirrhosis.

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Cirrhosis and Complications of Portal Hypertension

10.2310/tywc.1330 ◽

2018 ◽

Author(s):

Andres Cardenas ◽

Isabel Graupera ◽

Elsa Sola ◽

Pere Ginès

Keyword(s):

Liver Transplantation ◽

Portal Hypertension ◽

Variceal Bleeding ◽

Bacterial Infections ◽

Hepatorenal Syndrome ◽

Wide Spectrum ◽

Clinical Manifestations ◽

Diagnostic Methods ◽

Decompensated Cirrhosis ◽

Ultrasound Images

Cirrhosis is the most advanced stage of all the different types of chronic liver diseases. It is defined as a diffuse disorganization of normal hepatic structure by extensive fibrosis associated with regenerative nodules. Hepatic fibrosis is potentially reversible if the causative agent is removed. However, advanced cirrhosis leads to major alterations in the hepatic vascular bed and is usually irreversible. Cirrhosis is a progressive and severe clinical condition associated with considerable morbidity and high mortality. It leads to a wide spectrum of characteristic clinical manifestations, mainly attributable to hepatic insufficiency and portal hypertension. Major complications of portal hypertension include ascites, gastrointestinal (GI) variceal bleeding, hepatic encephalopathy (HE), renal failure, and bacterial infections. In recent years, major advances in the understanding of the natural history and pathophysiology of cirrhosis and the treatment of its complications have led to improved management, quality of life, and life expectancy of patients with this disease. Cirrhosis is also a risk factor for developing hepatocellular carcinoma (HCC). Decompensated cirrhosis carries a poor short-term prognosis; thus, orthotopic liver transplantation (OLT) should always be considered in suitable candidates. This chapter describes the epidemiology, etiology and genetic factors, pathogenesis, diagnosis, general management, and treatment of cirrhosis. Complications of cirrhosis are discussed, including ascites, spontaneous bacterial peritonitis, dilutional hyponatremia, hepatorenal syndrome, variceal bleeding, hepatopulmonary syndrome and postpulmonary hypertension, HE, and HCC. Indications and contraindications for liver transplantation are described. Figures show liver biopsy results and ultrasound images in cirrhosis from hepatitis C, a patient with tense ascites, transjugular intrahepatic portosystemic shunting (TIPS), large esophageal varices with red spots, and HCC. Tables outline the main causes of cirrhosis and the diagnostic methods for identifying them, the Child-Pugh score, diagnostic criteria for hepatorenal syndrome, grades of HE, and indications for liver transplantation.This chapter contains 6 highly rendered figures, 8 tables, 73 references.

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The potential of radionuclide diagnostic imaging in diffuse liver disease and portal hypertension

Transplantologiya The Russian Journal of Transplantation ◽

10.23873/2074-0506-2019-11-3-188-200 ◽

2019 ◽

Vol 11 (3) ◽

pp. 188-200

Author(s):

E. V. Migunova ◽

M. Sh. Khubutiya ◽

N. E. Kudryashova ◽

O. G. Sinyakova ◽

G. A. Berdnikov ◽

...

Keyword(s):

Bone Marrow ◽

Liver Transplantation ◽

Portal Hypertension ◽

Liver Function ◽

Objective Assessment ◽

Left Lobe ◽

Control Group ◽

Diffuse Liver Disease ◽

Quantitative Parameters ◽

Pugh Class

Objective. The study objective was to assess the scintigraphy potential in the evaluation of portal hypertension and the severity of liver damage in diffuse diseases and after liver transplantation.Material and methods. The study enrolled 325 patients suffering from hepatitis and liver cirrhosis of various etiology and severity, including those after liver transplantation, namely, the patients with hepatitis (n=96), patients with liver cirrhosis of Child–Pugh class A (n=24), class B (n=87), and class C (n=118); 11 more healthy volunteers without clinical and laboratory signs of diffuse liver disease were enrolled as controls. The assessment of liver reticuloendothelial system was performed by scintigraphy with (99m)Tc-phytate colloid in a static planar mode and "whole body" mode by SPECT (Infinia II, GE).Results. In contrast to the control group, significant radionuclide signs of hepatosplenomegaly were revealed with the predominant functional activity of the left lobe; the liver function was found impaired that correlated with the cirrhosis severity evaluated according to the Child–Pugh Сlassification. The analysis of scintigraphy quantitative parameters showed that the most informative of them were the intensity of radiopharmaceutical accumulation in the spleen (S%) and in bone marrow (Вm%), and the radiopharmaceutical uptake by the reticuloendothelial cells of the liver and spleen in percentage from the administered activity (Lwb%, Swb%). Depending on the cirrhosis severity assessed by the Child–Pugh Score, the changes in quantitative parameters were accompanied by a progressive enlargement of the spleen, liver left lobe, the increase of (99m)Tc-phytate uptake by the bone marrow with a decreased radiopharmaceutical uptake by the liver. The study results showed that among the Child–Pugh class C patients, the impairment of liver reticuloendothelial function was more pronounced in the patients with cirrhosis of viral and mixed etiology, when compared to those with alcoholic cirrhosis.Conclusion. The paper has identified the most informative parameters characterizing portal hypertension and the reticuloendothelial function for all Child–Pugh defined classes of cirrhosis. These parameters include the increase of (99m) Tc-phytate accumulation in the spleen (S%) and bone marrow (Bm%); the liver and spleen uptake of the radiopharmaceutical in percentage from the administered activity (Lwb%, Swb%). The calculation of the remaining parameters is necessary for a detailed description of the organ function and for the assessment of the portal hypertension severity in repeated studies.Summary. Criteria for the objective assessment of reticuloendothelial function and portal hypertension in diffuse liver diseases, including after liver transplantation, have been developed. Contrary to the control group, in patients with diffuse liver diseases, the radionuclide signs of hepatosplenomegaly (or a decreased liver size) with a predominant functional activity of the left lobe were identified, as were the changes in the quantitative parameters of the radiopharmaceutical uptake by the liver (Lwb%), including the radiopharmaceutical accumulation in the liver left lobe (Ll%), spleen (Swb%), bone marrow (Bm%), and the liver-to-spleen area ratio (Lar/Sar). The informative and reliable (p<0.05) parameters of the function Lwb%, S%, Swb% and Bm% correlating with the cirrhosis classes assessed by Child–Pugh were identified. The radionuclide method, being highly reproducible one, can be recommended for an objective assessment of liver function and the detection of portal hypertension in hepatitis and cirrhosis, as well as for post-transplant monitoring of the liver function to prevent complications in the early and late postoperative periods.

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Correction of extrahepatic portal hypertension in pediatric patient after liver transplantation

Russian Journal of Transplantology and Artificial Organs ◽

10.15825/1995-1191-2017-1-47-51 ◽

2017 ◽

Vol 19 (1) ◽

pp. 47-51

Author(s):

A. R. Monakhov ◽

B. L. Mironkov ◽

T. A. Dzhanbekov ◽

K. O. Semash ◽

Kh. M. Khizroev ◽

...

Keyword(s):

Liver Transplantation ◽

Blood Flow ◽

Portal Hypertension ◽

Portal Vein ◽

Pediatric Patient ◽

Portal Blood Flow ◽

Portal Blood ◽

Positive Trend ◽

Portal Vein Stenosis ◽

Vein Stenosis

Introduction. Liver transplantation is a multi-component and complex type of operative treatment. Patients undergoing such a treatment sometimes are getting various complications. One of these complications is a portal hypertension associated with portal vein stenosis.Materials and methods. In 6 years after the left lateral section transplantation from living donor in a pediatric patient the signs of portal hypertension were observed. Stenosis of the portal vein was revealed. Due to this fact percutaneous transhepatic correction of portal vein stenosis was performed.Results. As a result of the correction of portal blood flow in the patient a positive trend was noted. According to the laboratory and instrumental methods of examination the graft had a normal function, portal blood flow was adequate. In order to control the stent patency Doppler ultrasound and MSCT of the abdominal cavity with intravenous bolus contrasting were performed. Due to these examinations the stent function was good, the rate of blood flow in the portal vein due to Doppler data has reached 80 cm/sec, and a decrease of the spleen size was noted.Conclusion. Diagnosis and timely detection of portal vein stenosis in patients after liver transplantation are very important for the preservation of graft function and for the prevention of portal hypertension. In order to do that, ultrasound Doppler fluorimetry examination needs to be performed to each patient after liver transplantation. In cases of violation of the blood flow in the portal vein CT angiography performance is needed. Percutaneous transhepatic stenting of portal vein is a minimally invasive and highly effective method of correction of portal hypertension. Antiplatelet therapy and platelet aggregation control are the prerequisites for successful stent function.

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