Understanding the splenic contribution to portal flow: The role of splenic artery ligation as inflow modification in living donor liver transplantation
✍ Scribed by Dympna M. Kelly; Charles Miller
- Publisher
- John Wiley and Sons
- Year
- 2006
- Tongue
- English
- Weight
- 67 KB
- Volume
- 12
- Category
- Article
- ISSN
- 1527-6465
- DOI
- 10.1002/lt.20880
No coin nor oath required. For personal study only.
✦ Synopsis
Much of the work evaluating and predicting portal hypertension and the effect of pharmacological treatment on portal vein pressure emanated from the management of patients with cirrhosis with esophageal varices. Hepatic venous pressure gradient (HVPG) is the gold standard for assessing portal hemodynamics. Feu et al. 1 demonstrated that pharmacologic reduction in HVPG to 12 mm Hg or less, or by more than 20% was associated with zero risk of variceal rebleeding.
The presence of varices and variceal hemorrhage and/or ascites is indicative of the presence of clinically significant portal hypertension, 3 defined as an increase in HVPG Ͼ10 mm Hg, (normal Ͻ5 mm Hg) Other useful predictive parameters are platelet count, splenomegaly, and ascites, all of which are independent predictors of large esophageal varies in patients with cirrhosis. Madhotra et al. reported that a platelet count Ͻ68,000 was 71% sensitive and 73% specific in predicting large varices. Intuitively, one expects more severe varices to be associated with more advanced liver disease, but variceal size or grade does not correlate with CTP class.
Schepis et al. 6 evaluated clinical, biochemical, and portal Doppler parameters for predicting varices and selecting patients for endoscopic examination. By means of stepwise logistic regression, the presence of varices was independently predicted by prothrombin activity Ͻ70%, portal vein diameter Ͼ13 mm, and platelet count Ͻ100 ϫ 10 9 . Identifying the degree of portal hypertension in the patient with cirrhosis can be