Variations in Hepatic Vein Pressure Gradient and Liver Stiffness in the Histological Categories of Non-cirrhotic Portal Hypertension

Abstract

Introduction: Non-cirrhotic portal hypertension (NCPH) usually has lower liver stiffness (LS) and hepatic pressure gradient (HPVG), than cirrhosis. At times, it can have elevated LS and HVPG and be confused with liver cirrhosis. In this study we aimed to categorize those entities of NCPH with higher values of LS and HVPG for the prognostic relevance. Patients & Methods: This study included liver biopsy cases diagnosed as NCPH (2015-2021). Age and gender-matched controls of cryptogenic cirrhosis (n=127) were included. Parameters were obtained from the electronic records. The histological categories were- Obliterative portal venopathy (OPV), OPV with bridges (OPV-F), incomplete septal cirrhosis (ISC), nodular regenerative hyperplasia (NRH), mega sinusoids with fibrosis (MSF) and unclassified. Results: Mean age of study participants (n=173) was 39 (27.5-50) years. LS and HVPG were significantly lower than the cirrhosis {8 (6-12) vs 16 (14-17) Kpa; and 8 (6.9-11.7) vs. 27 (23-36), p<0.001. NCPH categories were- OPV {45, (26%)}, OPV- {37, (21.4%)}, ISC {20, (11.6%)}, NRH {19, (11%)}, MSF {19, (11%)}, and unclassified {33, (19%)}. Elevated HVPG noted in OPV-F {15(12-16)} and ISC {12 (9-14)} mmHg and correlated with fibrosis quantity. A HVPG >10 mmHg was: OPV (0/45, 0%), OPV-F (29/37, 78.3%), ISC (13/20, 65%), NRH (8/19, 42%), MSF (1/19, 5.2%), and unclassified (1/33, 3%) with p<0.001. Higher values of TE recorded in MSF and NRH, as compared to other categories. Conclusions: OPV-F and ISC have more fibrosis contents and higher HVPG values than the other categories of NCPH. Whereas, MSF and NRH have spuriously high liver stiffness.