Measurement Of Portal Venous Pressure Research Articles

A compact machine perfusion device for whole blood perfusion in isolated rat liver.

We established a compact machine perfusion system for whole blood perfusion of rat liver by making use of oxygenation filters as an artificial lung. Livers removed from rats were divided into Krebs-Henseleit (control), 50% blood (hemoglobin: 7g/dL), and whole blood (hemoglobin: 14g/dL) groups, then perfused (total perfusate volume: 25ml) with a small oxygenation filter at 37°C for 120min. Blood or perfusate was collected over time, and blood gas and blood cell were measured. In addition, bile volume and portal venous pressure measurements were taken. In all groups, the partial pressure of oxygen was controlled to approximately 400mmHg. Flow rates were maintained at approximately about 20-30ml/min according to liver size. Portal venous pressure was normal in the 50% blood and whole blood groups, while lower than the reference value in the Krebs-Henseleit group. Twice as much bile was produced in the 50% blood and whole blood groups relative with the Krebs-Henseleit group. We observed no differences in hemoglobin and red blood cell levels. Lactate levels were normal in the 50% blood and whole blood groups, but were elevated in the Krebs-Henseleit group. Our compact perfusion system using oxygenation filters was able to maintain rat liver function by perfusing a small amount of extracorporeal blood. This system is simple and stable, and may contribute to the future development of machine perfusion systems.

Feasibility and safety of ultrasound-guided percutaneous transhepatic measurement of portal venous pressure.

The measurement of portal venous pressure (PVP) has been extensively studied, primarily through indirect methods. However, the potential of ultrasound-guided percutaneous transhepatic PVP measurement as a direct method has been largely unexplored. This study aimed to investigate the accuracy, safety, and feasibility of this approach. In vitro, the experiment aimed to select a needle that could accurately transmit pressure, had a small inner diameter and was suitable for liver puncture, and performed on 20 healthy New Zealand white rabbits. An ultrasound-guided percutaneous transhepatic portal vein puncture was undertaken to measure PVP. Additionally, free hepatic venous pressure (FHVP) and wedged hepatic venous pressure (WHVP) were measured under digital subtraction angiography (DSA). The correlation between the two methods was assessed. Enroll study participants from October 18, 2023 to November 11, 2023 with written informed consent. Five patients were measured the PVP under ultrasound guidance before surgery to determine the feasibility of this measurement method. There was no significant difference in the results obtained using 9 different types of needles (P > 0.05). This demonstrated a great repeatability (P < 0.05). The 22G chiba needle with small inner diameter, allowing for accurate pressure transmission and suitable for liver puncture, was utilized for percutaneous transhepatic PVP measurement. There were positive correlations between PVP and HVPG (r = 0.881), PVP and WHVP (r = 0.709), HVPG and WHVP (r = 0.729), IVCP and FHVP (r = 0.572). The PVP was accurately and safely measured in 5 patients with segmental hepatectomy. No complications could be identified during postoperative ultrasound. Percutaneous transhepatic portal venous puncture under ultrasound guidance is accurate, safe and feasible to measure portal venous pressure. This study has been registered in the Chinese Clinical Trial Registry with registration number ChiCTR2300076751.

Development of a Direct Non-Puncture Device for Measuring Portal Venous Pressure during Liver Transplantation-A Swine Model.

Portal hypertension-related complications pose a significant risk for liver failure post-transplantation. Thus, accurate monitoring of intraoperative portal venous pressure (PVP) is crucial. However, current PVP monitoring techniques requiring direct percutaneous puncture carry the risk of graft damage. In this study, we present an innovative non-puncture PVP monitoring device (PVPMD) using a 3D-printed prototype. PVPMD design is inspired by the sphygmomanometer principle, and strategically encompasses the portal vein and enables precise PVP measurement through blood flow ultrasonography after temporary occlusion. By a series of mini-pig experiments, the prototype PVPMD demonstrated a strong correlation with invasive catheter measurements in the main trunk of the portal vein (rs = 0.923, p = 0.000). There was a significant repeatability and reproducibility between the prototype PVPMD- and invasive catheter-measured PVP. This indicates that the PVPMD holds immense potential for direct application in liver transplantation and surgery. Moreover, it has the potential to replace catheter-based central venous pressure (CVP) measurements, thereby mitigating catheter-related complications during many surgeries. In conclusion, our innovative device represents a significant advancement in PVP monitoring during liver transplantation, with comprehensive validation from principle exploration to successful animal experiments. We anticipate that this groundbreaking PVPMD will attract the attention of researchers and clinicians, propelling the noninvasive measurement of PVP or other venous/arterial pressures into a new era of clinical practice.

Effects of endoscopic gastric plication on portal pressure gradient in a patient with nonalcoholic steatohepatitis cirrhosis.

Video 1Endoscopic gastric plication (EGP) to treat obesity and nonalcoholic steatohepatitis (NASH) in a patient with compensated cirrhosis, as well as the application of EUS-guided portal pressure gradient (EUS-PPG) measurement to monitor changes in PPG after EGP.

Resection of hepatocellular carcinoma in patients with portal hypertension: long-term results based on direct intraoperative measurement of portal venous pressure

Introduction: The existence of differences in long-term prognosis of hepatocellular carcinoma (HCC) patients with or without portal hypertension (PH) undergoing hepatic resection remains controversial. Our aim was to clarify the long-term prognosis of HCC patients with PH undergoing hepatectomy. PH diagnosis was based on intraoperative portal venous pressure (PVP) measurement. Materials and Methods: Between May 2001 and April 2005, 68 patients with HCC underwent liver resection. PVP was directly measured at the beginning of surgery. Patients were divided into a high (&gt;11 mm Hg) (n=33) or a low (≤11 mm Hg) (n=35) PVP group. Clinicopathologic factors and postoperative outcomes were compared between the 2 groups, with tumor staging stratification according to Milan criteria (selection criteria for patients receiving transplantation). Median follow-up time was 101 months. Results: Postoperative mortality was 0. Median PVP was 10.7 mm Hg (range; 2.9–23.5 mm Hg). Compared with patients with low PVP, patients with high PVP had lower platelet counts, lower serum albumin levels, higher ALT concentration, higher international normalized ratio, higher Model for End-Stage Liver Disease (MELD score), and increased blood loss and blood transfusion. Multivariate logistic regression analysis revealed factors related to high PVP: serum albumin level &lt;3.6 g/dL (odd ratio: 5.532, 95% confidence interval: 1.286-23.79, P=0.022), and MELD score &gt;6 (odd ratio: 5.585; 95% confidence interval: 1.638-19.040, P=0.006). Postoperative morbidity was comparable between the 2 groups. Overall survival and disease-free survival rates in the high PVP group were significantly lower than in the low PVP group (P&lt;0.05). Subgroup analysis showed that, for patients within Milan criteria, those in the high PVP group had lower overall survival (P=0.032) and disease-free survival (P=0.016) than in those in the low PVP group. For patients outside the Milan criteria, no differences in survival were observed. Conclusions: In patients with early stage HCC undergoing resection, high PVP is associated with impaired long-term prognosis. For these patients, close follow-up and early salvage liver transplants for recurrent disease may be necessary to improve long-term prognosis after surgery.

Long-term Functional Maintenance of Exteriorized Portal Venous Catheters in a Porcine Animal Model

BackgroundPortal venous access for blood sampling, infusion therapy, and measurement of portal venous pressure is of special interest for experimental studies in surgery, pharmacology, and hepatology. Chronic animal models with continuous portal venous access are rare and especially thrombosis or clotting of permanent catheters is a frequent complication. Aim of this study was to establish a preclinical pig model with a permanent portal venous catheter (PVC). Materials and methodsPVC implantation was performed in 21 LEWE mini pigs. The catheter was inserted in the distal part of the superior mesenteric vein and fixated with a tobacco-pouch suture. Animals were followed up for 4 wk, directly after implantation of the PVC. Blood gas analyses and portal venous pressures were recorded. Three different groups with continuous infusion via the catheters were defined: NaCl solution (2 mL/h) (group 1), NaCl solution (2 mL/h) + enoxaparin sodium injection (anti-Xa levels of 0.3-0.8 U/mL) (group 2) and heparinized NaCl (2 I.E./mL, 2 mL/h) (group 3). ResultsAll 21 PVC implantations were performed without any complications. Application of continuous perfusion with heparinized NaCl (group 3) enabled portal venous access for the entire experiment in 8 of 10 cases (mean of 23.7 d) without any signs of dysfunction. However, for use of NaCl alone or in combination with enoxaparin sodium, catheters were only functional for 6.8 d and 6.9 d, respectively. ConclusionsPermanent portal venous access through PVC in mini pigs is achievable by continuous infusion of low-dose heparinized NaCl solution.

Clinical value of portal venous pressure based on three dimensional reconstruction model of portal vein combined with finite element analysis in patients with portal hypertension

Objective To study the clinical value of three-dimensional CT reconstruction model of portal venous system combined with finite element analysis to measure portal venous pressure in patients with portal hypertension. Methods A retrospective study was conducted on 27 patients who were diagnosed to have portal hypertension at the Second Affiliated Hospital of Kunming Medical University from May 2016 to May 2018. There were 17 males and 10 females, with ages ranging from 34 to 77 years (mean 56 years). All these patients underwent transjugular intrahepatic portal venous shunt (TIPS) during which the portal venous pressure was measured. The imaging data was imported into the three-dimensional software of medical imaging to reconstruct the three dimensional model of portal vein, and the finite element analysis software of ANSYS was used to calculate the portal venous pressure by calculation with given boundary conditions. Pearson correlation was used to analyze the correlation between the actual measurement of portal venous pressure and the predicted value. Results The actual measured value of portal vein pressure before TIPS in 27 patients with portal hypertension was (3 783±930) Pa, and the predicted value was (4 238±1 218) Pa. There was no significant difference (P>0.05). The predicted value of portal venous pressure was positively correlated with the actual measured value (r=0.402, 95%CI: 0.026-0.678, P<0.05). Conclusion Non-invasive measurement of portal venous pressure based on three-dimensional portal venous reconstruction combined with finite element analysis correlated with actual portal venous pressure in patients with portal hypertension. Key words: Hypertension, portal; Imaging, three-dimensional; Multislice spiral computerized tomography; Correlation

Hepatic venous pressure gradient after portal vein embolization: An accurate predictor of future liver remnant hypertrophy

BackgroundThe impact of portal hemodynamic variations after portal vein embolization on liver regeneration remains unknown. We studied the correlation between the parameters of hepatic venous pressure measured before and after portal vein embolization and future hypertrophy of the liver remnant after portal vein embolization. MethodsBetween 2014 and 2017, we reviewed patients who were eligible for major hepatectomy and who had portal vein embolization. Patients had undergone simultaneous measurement of portal venous pressure and hepatic venous pressure gradient before and after portal vein embolization by direct puncture of portal vein and inferior vena cava. We assessed these parameters to predict future liver remnant hypertrophy. ResultsTwenty-six patients were included. After portal vein embolization, median portal venous pressure (range) increased from 15 (9–24) to 19 (10–27) mm Hg and hepatic venous pressure gradient increased from 5 (0–12) to 8 (0–14) mm Hg. Median future liver remnant volume (range) was 513 (299–933) mL before portal vein embolization versus 724 (499–1279) mL 3 weeks after portal vein embolization, representing a 35% (7.4–83.6) median hypertrophy. Post–portal vein embolization hepatic venous pressure gradient was the most accurate parameter to predict failure of future liver remnant to reach a 30% hypertrophy (c-statistic: 0.882 [95% CI: 0.727–1.000], P < 0.001). A cut-off value of post–portal vein embolization hepatic venous pressure gradient of 8 mm Hg showed a sensitivity of 91% (95% CI: 57%–99%), specificity of 80% (95% CI: 52%–96%), positive predictive value of 77% (95% CI: 46%–95%) and negative predictive value of 92.3% (95% CI: 64.0%–99.8%). On multivariate analysis, post–portal vein embolization hepatic venous pressure gradient and previous chemotherapy were identified as predictors of impaired future liver remnant hypertrophy. ConclusionPost–portal vein embolization hepatic venous pressure gradient is a simple and reproducible tool which accurately predicts future liver remnant hypertrophy after portal vein embolization and allows early detection of patients who may benefit from more aggressive procedures inducing future liver remnant hypertrophy. (Surgery 2018;143:1-2.)

Portal venous pressure and proper graft function in living donor liver transplants in 69 patients from an Egyptian center.

BACKGROUNDSeveral studies have defined the optimal portal pressure suitable for adequate graft renewal in liver transplantation (LT) but none have studied an Egyptian population to our knowledge.OBJECTIVESDetermine the level of portal venous pressure (PVP) for adequate graft function, and study the effect of PVP modulation on the outcome of LT in an Egyptian population.DESIGNCross-sectional, prospectively collected data.SETTINGLiver transplantation unit.PATIENTS AND METHODSThe study included adult cirrhotic patients who underwent right lobe liver donor living transplantation (LDLT) at our transplantation center. Intraoperative Doppler was performed on all LDLT patients. Two PVP measurements were obtained during the recipient operation: before PV clamping and after graft reperfusion. These PVP measurements were correlated with the results of intraoperative and postoperative Doppler findings and graft function. Mortality in the early postoperative period (<1 month) and development of small-for-size syndrome (SFSS) were recorded.MAIN OUTCOME MEASURESPVP, graft injury, and the effect of PVP modulation on the outcome of LT were the primary outcome measures. Secondary outcome measures were to correlate PVP to portal vein hemodynamics and intraoperative mean hepatic artery, peak systolic velocity, and also to correlate PVP with the postoperative graft function and mean postoperative platelet count.SAMPLE SIZE AND CHARACTERISTICS69 adult patients with end-stage liver disease.RESULTSPost-reperfusion PVP was lower than pre-clamping PVP. The mean pre-clamping and post-reperfusion values were higher in patients who experienced early mortality and in patients with smaller grafts. A PVP greater than 16.5 mm Hg at the end of the operation predicted the development of SFSS (sensitivity=91.7% and specificity=50.5%). Cases of high PVP that were modulated to a lower level had a smooth and uneventful postoperative outcome.CONCLUSIONPVP is a significant hemodynamic factor that influences the functional status of the transplanted liver, including the development of SFSS, in the Egyptian population. PVP modulation may improve the outcome of LDLT.LIMITATIONSFurther study with a larger sample is needed to confirm these results.

Comparison of physical parameter measurements between peripheral and portal blood samples in patients with portal hypertension.

Measuring portal venous pressure is necessary to examine, diagnose, and treat portal hypertension, but current methods are invasive. This study aimed to determine whether a noninvasive peripheral blood measurement could be used to estimate portal venous pressure by investigating correlations between certain physical parameter measurements in the peripheral blood with those obtained in portal blood samples. A total of 128 peripheral and portal blood samples from patients (n= 128) were analyzed for blood rheology and routine blood parameters. The mean peripheral and portal whole blood viscosities under the shear rates of 200 s-1 (BV 200 s-1) were 2.97 ± 0.50 mPa.s and 3.06 ± 0.39 mPa.s. The mean peripheral and portal BV 30 s-1 values were 3.96 ± 0.79 mPa.s and 4.16 ± 0.64 mPa.s. We observed strong correlations between peripheral and portal blood measurements of BV 200 s-1 (r2= 0.9649), BV 30 s-1 (r2= 0.9622), BV 5 s-1 (r2= 0.9610), and BV 1 s-1 (r2= 0.9623). Our results indicate that peripheral blood can be used to evaluate certain parameters in portal blood for use in biofluid mechanics studies, and to provide noninvasive measurement of portal venous pressure.

Portal Vein Pressure Change Predicts Posthepatectomy Liver Failure Following Right Lobectomy

The aim of this study was to evaluate the usefulness of intraoperative portal venous pressure (PVP) as a predictor of posthepatectomy liver failure (PHLF). Hepatic functional reserve is typically evaluated by using parameters such as albumin level, platelet count, prothrombin activity level, or indocyanine green retention rate at 15 minutes. Low hepatic functional reserve can enhance the risk of PHLF. We retrospectively analyzed the outcomes of 35 patients who underwent right lobectomy and intraoperative PVP measurements between April 2004 and August 2012. According to preoperative prediction scores, all patients were within a safe limit for right lobectomy. The patients were grouped into uncomplicated (n = 22) and PHLF (n = 13) groups by postoperative course. PHLF was defined as grade B or C according to International Study Group of Liver Surgery criteria. Patient background, intraoperative bleeding, operative time, and PVP elevation after hepatectomy (ΔPVP) grade were compared between the groups. No cases of in-hospital death occurred. Univariate analysis revealed significant differences in preoperative white blood counts, intraoperative bleeding, and ΔPVP between the groups (P &amp;lt; 0.05). The ΔPVP was an independent risk factor on multivariate analysis. A ΔPVP &amp;gt;3 cmH2O was associated with PHLF at 69.2% sensitivity and 90.9% specificity. Following right lobectomy, a ΔPVP &amp;gt;3 cmH2O indicates a risk of PHLF and warrants careful postoperative management.

NON-INVASIVE PREDICTORS OF PORTAL HYPERTENSION IN PATIENTS WITH HEPATITIS C VIRUS RELATED HEPATOCELLULAR CARCINOMA.

The reference standard for portal venous pressure measurement which is clinically important for estimating the. feasibility of resection of hepatocellular carcinoma is the hepatic venous pressure gradient, which is, invasive and expqnsive. The present study evaluated the noninvasive parameters for assessment of portal hypertension in Child A patients with hepatocellular carcinoma on top of hepatitis C virus. A total of 112 patients were subjected to clinical assessment, biochemical assay, ultrasonographic Doppler study, triphasic spiral abdominal computed tomography, upper gastrointestinal endoscopy and hepatic venous pressure gradient measurement. According to hepatic venous pressure gradient measurement, they were classified into groups: GI: 58 patients with hepatic venous pressure gradient <10 mmHg and GII: 54 patients with hepatic venous pressure gradient > or = 10 mmHg. Significant variables in univariate analysis were included in a multivariate analysis to establish a model for prediction of clinically significant portal hypertension. Results showed that portal vein diameter > or = 1.3 cm, mono or biphasic pattern of flow in hepatic veins and Giannini index < or = 909 were independent risk factors for the clinically significant portal hypertension as indicated by HVPG > or = 10 mmHg. A model with highest likelihood ratio and good fitness was created. This prediction model was displayed by the receiver operating characteristic curve and under the curve area was 0.969 (0.938-1).

Usefulness of Intraoperative Measurement of Portal Venous Pressure for Confirming the Most Appropriate Hepatectomy in Patients with Borderline Hepatic Functional Reserve

Background We investigated whether portal venous pressure (PVP) measured immediately before surgery and then immediately after clamping of the Glissonian pedicle can be used to predict postoperative complications (ascites or jaundice) and thus select the extent of resection in patients with liver disease requiring hepatectomy. Methods Thirty-seven patients with hepatic functional reserve near the advisable limit and in whom direct measurement of PVP was done just before surgery and after clamping of the Glissonian pedicle were divided into two groups, an Event group (n = 9) and a Non-event group (n = 28), according to whether postoperative complications developed. The relation between PVP and the complication rate was analyzed, and a PVP safety margin was dent 昀ed. Results PVP obtained after the Glissonian pedicle was clamped was s gn 昀cantl higher in the Event group than in the Non-event group (18.8 vs. 15.7 cmH2O; p = 0.03). The PVP gradient de 昀ned as PVP after Glisso‐ nian clamping – PVP before surgery) tended to be greater in the Event group (5.1 versus 3.6 cmH2O; p = 0.13). PVP after Glissonian clamping plotted against the PVP gradient revealed safety margins of PVP gradient < 5 cmH2O and PVP < 20 cmH2O, respectively. Conclusion PVP after Glissonian clamping and the PVP gradient may be useful for predicting post-hepatec‐ tomy complications.

Image-guided Intervention in Management of Complications of Portal Hypertension: More than TIPS for Success

Management of clinically important sequelae of portal hypertension, such as variceal bleeding and ascites, may involve a combination of medical, endoscopic, surgical, and interventional approaches and procedures. Although clinically significant esophageal and rectal varices are typically visible endoscopically, ectopic varices may require multiplanar portal venous phase computed tomography or magnetic resonance imaging for diagnosis. A detailed understanding of individual vascular anatomy, flow dynamics, and patient-related factors such as cardiac and hepatic status is necessary for appropriate treatment selection in patients with complicated portal hypertension. The hepatic venous pressure gradient is the key indirect measurement of portal venous pressure. Transjugular intrahepatic portosystemic shunt (TIPS) placement is regarded as the archetypal intervention for treating complicated portal hypertension by reducing portal pressure. Various modifications, such as direct portocaval shunt, may be used in patients with challenging vascular anatomy. A subset of patients with obstructed hepatic venous outflow or portal venous inflow should be considered for recanalization. Splenic artery embolization may be considered for reduction of portal pressure in selected patients, particularly when hypersplenism or splenic vein occlusion is a prominent feature. Gastric and ectopic varices may bleed even when the portal pressure is low, and balloon-occluded retrograde transvenous obliteration (BRTO) in such patients may lead to equal or improved outcome compared with TIPS placement. BRTO is not limited by poor hepatic reserve or encephalopathy; however, it does not reduce portal pressure and may aggravate esophageal varices. Interventional radiology plays an important role in maintaining the patency of surgically created portosystemic shunts, and it remains at the forefront of new approaches in shunt design and placement. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.335125166/-/DC1.

Impact of deep sedation on the accuracy of hepatic and portal venous pressure measurements in patients with cirrhosis

Measurement of the hepatic venous pressure gradient (HVPG) offers valuable prognostic information in patients with cirrhosis. In specific circumstances, (children, agitated patients, TIPS placement) deep sedation is required. This study aims to assess the impact of deep sedation on the accuracy of hepatic/portal pressure measurements. Forty-four patients were included. Measurements of baseline HVPG (n = 30), HVPG response to i.v. propranolol (n = 11), portal pressure gradient (PPG) after TIPS (n = 27) and of cardio-pulmonary pressures (n = 25) were obtained in awake conditions and under deep sedation with propofol and remifentanil. During deep sedation, a marked oscillation within respiratory cycle was observed in abdominal pressures. End-expiratory sedated HVPG showed a better agreement with awake HVPG (intra-class correlation coefficient - ICC 0.864) than end-inspiratory HVPG (ICC 0.796). However, in almost half of the patients both values differed by more than 10%. Accuracy was not improved by using mean HVPG along the respiratory cycle. Similarly, changes in HVPG caused by propranolol while under sedation had a poor agreement to those obtained in awake conditions. Indeed, about a half of patients were misclassified according to the 10% HVPG reduction target. After TIPS, PPG values obtained under sedation were significantly different to awake PPG, usually underestimating the awake value. The systemic hemodynamic changes induced by sedation were not associated to a greater variability of PPG/HVPG measurements. Deep sedation with propofol and remifentanil adds substantial variability and uncertainty to HVPG/PPG measurements. This must be considered when using these values to estimate prognosis, or targeting HVPG/PPG reductions.

Successful Treatment of Rapid Onset, Symptomatic de novo Non-alcoholic Steatohepatitis Following Liver Transplantation: A Case Report

A 45 year old female with a body mass index (BMI) of 24 underwent successful liver transplantation (LT) for alcoholic cirrhosis using a donor liver from an obese woman with microvesicular steatosis (80%) and minimal macrovesicular steatosis (5-10%) on liver biopsy. Ascites and hepatosplenomegaly developed soon after LT with progressive increase of serum alkaline phosphatase to 1340IU/L while aspartate aminotransferase (AST), and alanine transaminase (ALT), and total bilirubin remained normal. Imaging showed marked hepatomegaly, extensive fatty infiltration of the liver, and compression of the hepatic veins with narrowing of the intrahepatic inferior vena cava (IVC). Liver biopsy on post-operative day 39 revealed 90-100% macrovesicular steatosis, steatohepatitis, and portal fibrosis. A hepatic venogram showed a 10cm segment of intrahepatic IVC stenosis that was stented, improving portal venous pressure measurements. However, portal hypertension requiring diuretic therapy and multiple paracenteses remained. By 3 months after LT, her liver had grown to 22cm, transaminases increased 2-4 times the upper limit of normal with a 2:1 AST to ALT ratio. Liver biopsy at post-LT day 82 showed no change in steatosis and steatohepatitis despite corticosteroid withdrawal and interval periportal and perisinusoidal fibrosis. 12 weeks after LT, the patient was found to have low apolipoprotein B (65mg/dL), high-density lipoprotein (HDL) (<10mg/dL), low-density lipoproteins (LDL) (9mg/dL), and total cholesterol (<50mg/dL) levels. Therapy was started for NASH with high dose (800IU daily) vitamin E and pioglitazone 15mg daily, and she received topical vegetable oil and oral essential fatty acid supplements. Liver enzymes normalized after 3 months and her lipid profile improved markedly (HDL 27mg/dL, total cholesterol 128mg/dL), with progressive decrease in liver size and resolution of ascites after 5 months of therapy. At 2 years post-LT, the liver enzymes remain normal and lipids have normalized.

Severity of portal hypertension and prediction of postoperative liver failure after liver resection in patients with Child–Pugh grade A cirrhosis

Patients with Child-Pugh grade A cirrhosis and clinical evidence of portal hypertension are likely to develop posthepatectomy liver failure (PHLF). Whether such patients are suitable candidates for partial hepatectomy is controversial. This study explored the impact of portal venous pressure (PVP) on PHLF and the possibility of stratifying patients with Child-Pugh grade A cirrhosis for risk of PHLF using clinical data alone. Between April 2009 and May 2011, consecutive patients who underwent partial hepatectomy for hepatocellular carcinoma and intraoperative measurement of PVP were included in this prospective study. Using signs of clinically significant portal hypertension (CSPH), patients with Child-Pugh grade A cirrhosis were subclassified into three groups: no, mild and severe CSPH. Risk factors for PHLF were subjected to univariable and multivariable analysis, and receiver operating characteristic (ROC) curve analysis. Sixty-seven (35·3 per cent) of 190 patients developed PHLF, which was persistent in 12 patients (6·3 per cent). Four patients (2·1 per cent) died from PHLF within 3 months of surgery. Multivariable analysis showed both PVP and CSPH to be independent predictors of PHLF (P < 0·001). PVP values, incidence of PHLF and persistent PHLF were significantly higher in the severe CSPH group than in the other two groups (P < 0·001). Severe CSPH (odds ratio 27·68, P = 0·005) and a preoperative neutrophil : lymphocyte ratio (NLR) of 2·8 or above (odds ratio 49·75, P = 0·002) were independent factors affecting the incidence of persistent PHLF. The severity of CSPH, corresponding to different PVP levels, could be used to stratify patients with Child-Pugh grade A cirrhosis and to predict the incidence of PHLF. Patients with severe CSPH or a NLR of 2·8 or above were more likely to develop persistent PHLF after partial hepatectomy.

Intraoperative portal venous pressure and long-term outcome after curative resection for hepatocellular carcinoma

Outcomes of liver resection for hepatocellular carcinoma (HCC) have improved owing to better surgical techniques and patient selection. Portal hypertension may influence outcome but the preoperative definition and role of portal hypertension are far from clear. The aim of this study was to elucidate the influence of portal venous pressure (PVP) measured directly during surgery on outcomes of liver resection in patients with HCC. Patients who had resection of HCC between 1997 and 2009, and who underwent direct measurement of PVP immediately after laparotomy were enrolled. These patients were divided into groups with high (at least 20 cmH(2)O) and low (less than 20 cmH(2)O) PVP. The influence of PVP on overall and recurrence-free survival was analysed and prognostic factors were identified. A total of 177 patients were enrolled, 129 in the low-PVP group and 48 in the high-PVP group. The 5-year overall survival rate (63·7 versus 31 per cent; P < 0·001) and recurrence-free survival rate (52·5 versus 12 per cent; P < 0·001) were significantly higher in patients with low PVP. In multivariable analysis, two or more tumours, tumour diameter at least 5 cm, high PVP, grade B liver damage and Hepatic Activity Index (HAI) grade 7 or more were significant predictors of poorer survival after liver resection. Two or more tumours, tumour diameter at least 5 cm and HAI grade 7 or more were significant predictors of poorer recurrence-free survival. High PVP was associated with poor long-term outcome after liver resection for HCC.

P97 Post-liver reperfusion hepatic vein portal gradient pressure measurement and the risk of graft dysfunction in whole liver transplantation

Introduction“Small for size liver syndrome” is relatively uncommon after whole liver transplantation. Portal hyperperfusion is thought to damage the hepatic microvasculature, and drive Small for size liver syndrome. Post-perfusion portal...

Duplex Doppler Ultrasound Examination of the Portal Venous System: An Emerging Novel Technique for the Estimation of Portal Vein Pressure

Measurement of portal venous pressure in patients with portal hypertension is important to assess efficacy of beta blockers in patients with esophageal varices. Currently, the gold standard for measurement of portal venous pressure is the estimation of hepatic venous pressure gradient (HVPG). Being an invasive technique, serial measurements of HVPG are not feasible in clinical practice. In this respect, duplex Doppler ultrasound (DDUS) examination is an upcoming non-invasive technique for the estimation of portal venous and splanchnic hemodynamics. The aim of the present review is to analyze the current literature focusing on how the two techniques compare to each other in terms of assessing the portal pressure and assessing pitfalls in the current technique. Duplex Doppler ultrasound (DDUS) currently has limitations in measuring the portal pressure in a non-invasive way. Hemodynamic venous and arterial indices measured on DDUS correlate with the HVPG. The technique has been refined, however, there is no uniform surrogate marker that can be used in clinical practice. More studies are needed in order to remove the shortcomings in the current technique. The target is to be able to measure the actual portal pressure or at least derive an ideal venous or arterial hemodynamic surrogate marker having close correlation with the HVPG.