Hepatic Venous Pressure Gradient

Bochnakova, Teodora

doi:10.1002/cld.1031

Cited by 28 publications

(22 citation statements)

References 23 publications

(27 reference statements)

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“…In individuals with transjugular liver biopsies, hepatic venous pressure gradient (HVPG) measurements were evaluated (N = 8). HVPG >5 and >10 mmHg were used to define any portal hypertension and clinically significant portal hypertension, respectively (25). In CVID participants with abdominal CT imaging available (N = 13), spleen size was measured using the largest anterior-posterior diameter on axial imaging, with those ≥12 cm considered enlarged (26).…”

Section: Collection and Definition Of Clinical And Laboratory Datamentioning

confidence: 99%

Liver Stiffness by Transient Elastography Correlates With Degree of Portal Hypertension in Common Variable Immunodeficiency Patients With Nodular Regenerative Hyperplasia

et al. 2022

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Nodular regenerative hyperplasia (NRH) is associated with high morbidity and mortality in patients with common variable immunodeficiency (CVID). While liver biopsy is the gold standard for NRH diagnosis, a non-invasive technique could facilitate early disease recognition, monitoring, and/or immune intervention. We performed a cross-sectional analysis of ultrasound-based transient elastography (TE) in patients with CVID to evaluate liver stiffness and compared this between patients with (N = 12) and without (N = 6) biopsy-proven NRH. Additionally, these data were compared to a cohort followed at our institution for non-alcoholic fatty liver disease (NAFLD) (N = 527), a disease for which TE has routine diagnostic use. Clinical and pathologic features of NRH were evaluated as correlates of liver stiffness, and receiver operating characteristic curves were used to define a liver stiffness cutoff with diagnostic utility for NRH among CVID patients. CVID patients with NRH had a more severe disease presentation compared to those without. This included increased autoinflammatory disease comorbidities, combined B-cell and T-cell dysfunction, and abnormal liver biochemistries (specifically an increased mean alkaline phosphatase level [proximal to TE, 250 vs. 100 U/L; p = 0.03; peak, 314 vs. 114 U/L; p = 0.02). Results of TE demonstrated a significantly elevated liver stiffness in CVID patients with NRH (mean 13.2 ± 6.2 kPa) as compared to both CVID patients without NRH (mean 4.6 ± 0.9 kPa) and non-CVID patients with NAFLD (mean 6.9 ± 5.5 kPa) (p < 0.01). No single or composite histopathologic feature of NRH correlated with liver stiffness including nodule size, nodule density, sinusoidal dilation, fibrosis, and/or lymphocytosis. In contrast, liver stiffness by TE was significantly correlated with clinical parameters of portal hypertension, including an elevated hepatic venous pressure gradient, an increased splenic longitudinal diameter, presence of varices, and presence of peripheral edema. A liver stiffness of greater than or equal to 6.2 kPa was a clinically significant cutoff for NRH in CVID patients. We propose that TE has diagnostic utility in CVID, particularly in the presence of immunophenotypic features such as combined B-cell and T-cell dysfunction, autoinflammatory comorbidities, and/or abnormal liver tests. Elevated liver stiffness by TE should raise suspicion for NRH in patients with CVID and prompt expedited evaluation by hepatology.

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Section: Collection and Definition Of Clinical And Laboratory Datamentioning

confidence: 99%

Liver Stiffness by Transient Elastography Correlates With Degree of Portal Hypertension in Common Variable Immunodeficiency Patients With Nodular Regenerative Hyperplasia

et al. 2022

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“…PHT is classified as cirrhotic PHT and NCPH, which can be further differentiated by the hepatic venous pressure (HVP), which is the difference between the wedged HVP and the free HVP [ 5 ]. Higher HVP in cirrhotic PHT is due to sinusoidal resistance [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Nodular Regenerative Hyperplasia and Non-cirrhotic Portal Hypertension Post Oxaliplatin Chemotherapy

Ganta¹,

Prasad²,

Aknouk³

et al. 2022

Cureus

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Oxaliplatin is widely used in chemotherapeutic regimens for colorectal carcinoma, its recurrence, and metastasis, and is associated with better outcomes. However, oxaliplatin use is associated with injury to hepatic sinusoidal endothelium and the development of nodular regenerative hyperplasia (NRH) in the liver, which can be differentiated from nodular hyperplasia of cirrhosis by the presence of diffuse micronodular transformation without a fibrous band and the lack of perinuclear collagen tissue. This causes non-cirrhotic portal hypertension (NCPH), which presents with splenomegaly and variceal bleeding and preserved synthetic liver function. Its treatment revolves around managing variceal bleeding with banding, sclerotherapy, and beta blockers. Some patients may end up requiring liver transplantation because of recurrent variceal bleeding. We present the case of a 46 years old female who presented with recurrent variceal bleeding due to NCPH and NRH six years after treatment of colon carcinoma with oxaliplatin.

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“…In silico models are a powerful tool in simulating the hepatic circulation under abnormal conditions, which are often costly, challenging, or sometimes infeasible to quantify or measure in vivo or in vitro. For example, the hepatic venous pressure gradient (HVPG), which is used to diagnose portal hypertension, requires invasive insertion of a catheter into one of the hepatic veins under ultrasound and fluoroscopic guidance (Bochnakova, 2021;Wang et al, 2017Wang et al, , 2020. In silico model, such as that of (Wang et al, 2017), facilitate quantitative analysis of the interplay between portal pressure, trans-sinusoidal pressure, and HVPG, and thus may yield novel biomarkers for the diagnoses of portal hypertension.…”

Section: Modeling Hepatic Circulation Under Abnormal Liver Conditionsmentioning

confidence: 99%

In silico modeling for the hepatic circulation and transport: From the liver organ to lobules

Means

Safaei

et al. 2022

WIREs Mechanisms of Disease

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The function of the liver depends critically on its blood supply. Numerous in silico models have been developed to study various aspects of the hepatic circulation, including not only the macro-hemodynamics at the organ level, but also the microcirculation at the lobular level. In addition, computational models of blood flow and bile flow have been used to study the transport, metabolism, and clearance of drugs in pharmacokinetic studies.These in silico models aim to provide insights into the liver organ function under both healthy and diseased states, and to assist quantitative analysis for surgical planning and postsurgery treatment. The purpose of this review is to provide an update on state-of-the-art in silico models of the hepatic circulation and transport processes. We introduce the numerical methods and the physiological background of these models. We also discuss multiscale frameworks that have been proposed for the liver, and their linkage with the large context of systems biology, systems pharmacology, and the Physiome project.

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Hepatic Venous Pressure Gradient

Cited by 28 publications

References 23 publications

Liver Stiffness by Transient Elastography Correlates With Degree of Portal Hypertension in Common Variable Immunodeficiency Patients With Nodular Regenerative Hyperplasia

Liver Stiffness by Transient Elastography Correlates With Degree of Portal Hypertension in Common Variable Immunodeficiency Patients With Nodular Regenerative Hyperplasia

A Case Report of Nodular Regenerative Hyperplasia and Non-cirrhotic Portal Hypertension Post Oxaliplatin Chemotherapy

In silico modeling for the hepatic circulation and transport: From the liver organ to lobules

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