Histological subclassification of cirrhosis using the Laennec fibrosis scoring system correlates with clinical stage and grade of portal hypertension

Kim, Moon Young; Cho, Mee Yon; Baik, Soon Koo; Park, Hong Jun; Jeon, Hyo Keun; Im, Chang‐Hwan; Won, Chan Sik; Kim, Jae Woo; Kim, Hyun Soo; Kwon, Sang Ok; Eom, Min Seob; Hwan, Seung; Kim, Young Ju; Chang, Sei Jin; Lee, Samuel S.

doi:10.1016/j.jhep.2011.02.012

Cited by 154 publications

(161 citation statements)

References 29 publications

(45 reference statements)

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“…There is, however, a great deal of variation within this classification with respect to cirrhosis, such as the thickness of fibrous septa and nodule size. As a result, Laennac sub-classified cirrhosis into three separate grades based on the above features and this subclassification appears to correlate with clinical stage and degree of portal hypertension, as measured by the hepatic portal venous gradient (HVPG) [10]. Nagula et al as well as Garcia-Tsao et al have also highlighted the need to incorporate clinical, haemodynamic and biological features when developing a new sub-classification of cirrhosis [11,12].…”

Section: Assessment Of Fibrosismentioning

confidence: 99%

Clinical evidence for the regression of liver fibrosis

Ellis

Mann

2012

Journal of Hepatology

370

253

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Fibrosis is a common pathological process for the majority of liver diseases which in a significant minority of patients leads to end-stage cirrhosis and/or hepatocellular carcinoma. Data emerging from small rodent models of chronic liver disease have demonstrated that fibrotic extracellular matrix can be remodelled and near-normal hepatic architecture regenerated upon cessation of injury. Moreover, regression of liver fibrosis in these model systems can be stimulated with drugs that target the activities of fibrogenic hepatic stellate cells. These findings are exciting as they suggest that established fibrosis is susceptible to regression and possibly even reversion. Alongside these experimental studies is a growing body of clinical data that suggest regression of fibrosis may also occur in liver disease patients for whom an effective treatment is available for their underlying liver injury. This paper provides an up-to-date review of the currently available clinical data and also considers technical caveats that highlight the need for caution in establishing a new dogma that human liver fibrosis is reversible.

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Section: Assessment Of Fibrosismentioning

confidence: 99%

Clinical evidence for the regression of liver fibrosis

Ellis

Mann

2012

Journal of Hepatology

370

253

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“…Even in patients with stage IV disease, critical mass varies according to the parenchymal reserves. Modified Laennec Scoring System divides stage IV further, according to the thickness of septa into three, ending up in six stages altogether [34,35]. Moreover, ACLF is not equivalent to the acute decompensation of cirrhosis, which is the result of parenchymal extinction.…”

Section: Defining the Underlying Chronic Liver Diseasementioning

confidence: 99%

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

et al. 2014

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The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, ''APASL ACLF Research Consortium (AARC),'' was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the

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“…139 Their recommendation suggested that patients with cirrhosis and symptomatic portal hypertension or hepatic vein wedge pressure gradient ≥10 mm Hg should not undergo isolated kidney transplantation but should be considered for simultaneous kidney and liver transplantation. In patients with noncardiac liver disease, an elevated hepatic venous pressure gradient (HVPG) has been associated with the development of esophageal varices, 140 histologic cirrhosis, 141 and risk of liver decompensation. 142 Ripoll et al 142 found that patients with compensated cirrhosis and an HVPG <10 had a low probability (10%) of developing clinically decompensated cirrhosis at a median follow-up of 4 years.…”

Section: Systemic Venous Anomalies In Patients With Situs Inversus Ormentioning

confidence: 99%