Abstract
Microcirculatory dysfunction is associated with organ failure, poor response to vasoactive drugs and increased mortality in cirrhosis, but monitoring techniques are not established. We hypothesized that the chorioretinal structures of the eye could be visualized as a non-invasive proxy of the systemic microvasculature in cirrhosis and would correlate with renal dysfunction. Optical Coherence Tomography (OCT) was performed to image the retina in n = 55 cirrhosis patients being assessed for liver transplantation. OCT parameters were compared with established cohorts of age- and sex-matched healthy volunteers (HV) and patients with chronic kidney disease (CKD). Retinal thickness, macular volume and choroidal thickness were significantly reduced relative to HV and comparable to CKD patients (macular volume: HV vs. cirrhosis mean difference 0.44 mm3 (95% CI 0.26–0.61), p ≤ 0.0001). Reduced retinal thickness and macular volume correlated with renal dysfunction in cirrhosis (macular volume vs. MDRD-6 eGFR r = 0.40, p = 0.006). Retinal changes had resolved substantially 6 weeks following transplantation. There was an inverse association between choroidal thickness and circulating markers of endothelial dysfunction (endothelin-1 r = −0.49, p ≤ 0.001; von Willebrand factor r = −0.32, p ≤ 0.05). Retinal OCT may represent a non-invasive window to the microcirculation in cirrhosis and a dynamic measure of renal and endothelial dysfunction. Validation in different cirrhosis populations is now required.
Highlights
Decompensation and organ dysfunction in liver cirrhosis are characterised by systemic inflammation, regional microcirculatory alterations and profound systemic haemodynamic adaptations [1,2]
Optical Coherence Tomography (OCT) imaging metrics in cirrhosis patients were compared with pre-existing cohorts of age- and sex-matched healthy volunteers (HV) and chronic kidney disease (CKD) patients
It is possible that OCT scanning may represent a more effective indicator of renal risk when compared to serum creatinine or Estimated glomerular filtration rate (eGFR)
Summary
Decompensation and organ dysfunction in liver cirrhosis are characterised by systemic inflammation, regional microcirculatory alterations and profound systemic haemodynamic adaptations [1,2]. Despite normalisation of systemic haemodynamic variables in cirrhosis using fluids and vasoactive drugs, there is not necessarily a parallel improvement in microcirculatory perfusion and restoration of tissue oxygenation. This loss of haemodynamic coherence could explain the variability in response to terlipressin in patients with hepatorenal syndrome, illustrated by the drug’s heterogeneous effect on renal perfusion indices [9]. Assessment of the microcirculation could play a potentially critical role in understanding the complex pathophysiology in an individual patient, monitoring of treatment interventions, and prognostication across different clinical states of cirrhosis
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