Portal Hypertension and Liver Transplantation: Current Situation in Japan and Overseas

2019 ◽  
pp. 581-589
Author(s):  
Junichi Kaneko ◽  
Norihiro Kokudo
Keyword(s):  
Liver Transplantation ◽  
Portal Hypertension ◽  
Current Situation

Transplante Hepático: História, Panorama Atual, Perspectivas / Liver Transplantation: History, Current Situation, Prospects

1970 ◽  
Vol 5 (3) ◽  
Author(s):  
Marcelo Bruno de Rezende ◽  
Aldo Elias Kiyoshi Takano de Saidneuy ◽  
Luiz Gustavo Guedes Diaz ◽  
Marcela Balbo Rusi ◽  
Marcelo de Melo Viveiros ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Sao Paulo ◽  
Current Situation ◽  
São Paulo ◽  
America Latina ◽  
De Medicina

O transplante hepático revolucionou a expectativa de vida dos pacientes com doença hepática em estágio avançado, tornando-se muitas vezes a única modalidade terapêutica efetiva para uma variedade de doenças hepáticas crônicas ou agudas irreversíveis.1-4Deve-se a C. S. Welch as primeiras tentativas de transplante hepático experimental em cães, em 1955.5 Embora a técnica de transplante hepático em humanos tenha sido descrita inicialmente em 1960,6,7 o primeiro transplante de fígado no homem foi realizado em 1963 na Universidade do Colorado em Denver (EUA) por Thomas Starzl8 em um paciente de três anos de idade com atresia de vias biliares e que foi a óbito no transoperatório por sangramento. O primeiro transplante hepático realizado em humanos com sucesso foi alcançado por esta mesma equipe em 1967 em uma criança de um ano e meio com carcinoma hepatocelular.1Desde então a técnica operatória tem sido constantemente modificada e aprimorada, sendo necessárias quase duas décadas para que o transplante hepático se consolidasse como uma alternativa terapêutica cientificamente comprovada.O Brasil entra precocemente na era dos transplantes de fígado. Em 1965, o grupo de metabologia cirúrgica da Faculdade de Medicina da Universidade de São Paulo produz as primeiras pesquisas experimentais sobre transplante de fígado em cães. No dia 5 de agosto de 1968, foi realizado com sucesso técnico o primeiro transplante de fígado da América Latina no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), em um doente com 52 anos de idade, portador de cirrose hepática e carcinoma hepatocelular... 

Cirrhosis and Complications of Portal Hypertension

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.

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

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.

scholarly journals Correction of extrahepatic portal hypertension in pediatric patient after liver transplantation

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.

scholarly journals PORTAL HYPERTENSION INCREASE ANTI-DONOR IMMUNE RESPONSE AFTER LIVING DONOR LIVER TRANSPLANTATION IN PATIENTS AND MOUSE MODEL

2020 ◽  
Vol 104 (S3) ◽  
pp. S495-S496
Author(s):  
Takashi Onoe ◽  
Shinji Hashimoto ◽  
Masataka Banshodani ◽  
Kazuhiro Taguchi ◽  
Yuka Tanaka ◽  
...  
Keyword(s):  
Immune Response ◽  
Liver Transplantation ◽  
Portal Hypertension ◽  
Mouse Model ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Donor Liver ◽  
Donor Liver Transplantation

scholarly journals Vaginal varices with massive hemorrhage in a patient with nonalcoholic steatohepatitis and portal hypertension: Successful treatment with liver transplantation

2008 ◽  
Vol 14 (10) ◽  
pp. 1538-1540 ◽  
Author(s):  
Patrick P. McHugh ◽  
Hoonbae Jeon ◽  
Roberto Gedaly ◽  
Thomas D. Johnston ◽  
Paul D. DePriest ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Portal Hypertension ◽  
Successful Treatment ◽  
Nonalcoholic Steatohepatitis ◽  
Massive Hemorrhage

Complications of cirrhosis and portal hypertension

2013 ◽  
pp. 251-256 ◽  
Author(s):  
Daniel Marks ◽  
Marcus Harbord
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Spontaneous Bacterial Peritonitis ◽  
Early Stage ◽  
Nodule Formation ◽  
Architectural Distortion ◽  
Bacterial Peritonitis ◽  
Complications Of Cirrhosis

Causes and diagnosis of cirrhosis Causes and diagnosis of non-cirrhotic portal hypertension Ascites Spontaneous bacterial peritonitis Hepatorenal syndrome Variceal haemorrhage Hepatic encephalopathy Hepatopulmonary syndromes Hepatocellular carcinoma Cirrhosis occurs following progressive hepatic fibrosis, with architectural distortion of the liver and nodule formation. It is a histological diagnosis. Late-stage cirrhosis is irreversible, at which point only liver transplantation is curative. Early-stage cirrhosis has been shown to improve following treatment and may be asymptomatic....

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