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Objective:To investigate the predictors of rebleeding three months after treatment of esophageal and gastric variceal bleeding (EGVB) in patients with hepatitis B cirrhosis and the effects of different treatments on rebleeding.Methods:From January 2018 to January 2020, the hepatitis B cirrhosis patients with first onset of EGVB in the First Hospital of Lanzhou University were enrolled and followed up for three months. The development of rebleeding, information about portal vein flow velocity and model for end-stage liver disease (MELD) scores after treatment of first bleeding were collected. The statistical analysis was conducted by chi-square test and binary logistic regression analysis. The efficacy for predictors of rebleeding was evaluated by using area under the receiver operating characteristic curve.Results:Among the 33 patients with the first EGVB, the rebleeding rate during three months follow-up was 42% (14 cases), including one patient (1/8) who underwent transjugular intrahepatic portosystemic shunt, 10 patients (10/19) were treated with therapeutic endoscopy, and three patients (3/6) were treated with vasoactive drugs. No statistically significant difference in rebleeding rates was found among the three treatment groups ( χ2=3.853, P=0.175). Portal vein flow velocity after treatment for the first onset of EGVB (odds ratio ( OR)=0.21, 95% confidence interval ( CI) 0.05 to 0.93, P=0.039) and MELD score ( OR=1.53, 95% CI 1.02 to 2.30, P=0.040) were independent predictors for the occurrence of rebleeding events during three months. When the portal vein flow velocity after treatment for the first bleeding was 19 cm/s, the area under the receiver operating characteristic curve for prediction of the occurrence of rebleeding during three months was 0.86, with the sensitivity of 92% and the specificity of 61%. Conclusion:Among the patients with hepatitis B cirrhosis and the first onset of EGVB, different treatments may have little relationship with three-month rebleeding, while portal vein flow velocity ≤19 cm/s is the main predictor for rebleeding within three months.
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Objective To determine the risk factors associated with early allograft dysfunction (EAD) after liver transplantation. Methods We retrospectively analyzed the records of 138 patients who underwent liver transplantation from January 2006 to October 2016 in our department. Transplant recipients were divided into two groups:those who met the diagnostic criteria of EAD (EAD group) and those who did not (non-EAD group). We compared blood flow into the transplanted livers and other clinical features between the two groups using univariate and multivariate analysis. Results Intraoperative portal vein flow (PVF) maximum was significantly different between the two groups. Multivariate analysis revealed that intraoperative PVF maximum ＜1 600 mL/min was the only independent risk factor for the occurrence of EAD after liver transplantation in this cohort. Conclusion Intraoperative PVF maximum ＜1 600 mL/min is an independent risk factor for the occurrence of EAD after liver transplantation. Measuring intraoperative blood flow into the transplanted liver in liver transplant recipients may help identify patients at risk for developing EAD.
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ObjectiveTo investigate the effects of selective splenectomy on modulation of portal vein flow and prevention of small-for-size syndrome (SFSS) in living donor liver transplantation.MethodsTwenty six recipients who received LDLT from September 2007 to March 2008 were reviewed.The data of the portal vein flow of these recipients were collected during the operation.Simultaneous splenectomy was performed in patients with portal blood flow ＞250 ml/(min · 100g).No splenectomy was performed when the portal blood flow was less than 250 ml/(min · 100g).The effect of selective splenectomy on modulation of portal vein flow and whether splenectomy prevented the occurrence of SFSS were analyzed.ResultsThe portal vein flow decreased significantly after splenectomy in 8 patients who received splenectomy (P＜0.01),No SFSS occurred in the patients with or without splenectomy.Actual graft-to-recipient weight ratio (GRWR) of patients with splenectomy was significantly smaller than those with no splenectomy (P=0.044).The portal vein flow of patients with splenectomy was much higher than those with no splenectomy (P＜0.01).ConclusionAccording to the portal blood flow,selective splenectomy in LDLT decreased the portal vein flow and prevented the incidence of SFSS.
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PURPOSE: To investigate the changes occurring in portal hemodynamics in patients with esophageal and gastric varices, according to variceal type, before and after TIPS. MATERIALS AND METHODS: Between January 1994 and June 1999, we evaluated 22 of 44 patients who had undergone TIPS and endoscopy on admission. In these 22, hepatic venous and main portal venous pressure were measured. On the basis of endoscpic findings, the esophageal and gastric varices were classified as one of three types. Changes in portal hemodynamics in relation to the diameter of the portal vein, mean portosystemic gradient before and after TIPS, delta MPSG, and the presence of hepatic encephalopathy and gastrorenal shunt were all evaluated. RESULTS: Endoscopy indicated that there were ten Type-I cases, nine Type-II, and three Type-III. The diameter of the main portal vein was 14.95 +/-1.79 mm in Type I cases, and 13.35 +/-1.59 mm in Type II. Before TIPS, main portal venous pressure was 31.40 +/-6.79 mmHg (Type I) and 22.80 +/-4.26 mmHg (Type II), and the mean portosystemic gradient was 16.10 +/-7.0 mmHg (Type I), and 11.20 +/-5.36 mmHg (Type II). After TIPS, the pressure readings were 25.70 +/-7.60 mmHg (Type I) and 17.80 +/-6.52 mmHg (Type II), while those relating to were 10.80 +/-4.94 mmHg (Type I) and 5.25 +/-3.67 mmHg (Type II). delta MPSG was 6.04 +/-2.98 mmHg (Type I) and 5.91 +/-3.98 mmHg (Type II). Angiography revealed that the gastrorenal shunt was Type I in 10% of cases, Type II in 77%, and Type III in 33%. Hepatic encephalopathy after TIPS occured in three Type-I cases, three-Type- II, and two Type-III. CONCLUSION: The diameter of the main portal vein was significantly smaller, and portal venous pressure and mean portosystemic gradient before and after TIPS significantly lower in patients with dominant gastric varices than in those with dominant esophageal varices (p<0.05). Gastrorenal shunt was more frequent among patients with dominant gastric varices. No difference in the incidence of hepatic encephalopathy after TIPS was noted between those with dominant gastric varices and those with the esophageal variety.
Subject(s)
Humans , Angiography , Endoscopy , Esophageal and Gastric Varices , Hemodynamics , Hepatic Encephalopathy , Incidence , Portacaval Shunt, Surgical , Portal Pressure , Portal Vein , Portasystemic Shunt, Surgical , ReadingABSTRACT
PURPOSE: To evaluate the safety and the influence of embolization of severe arterioportal shunts, and the effect of the procedure on the survival rate of patients with hepatocellular carcinoma combined with portal vein tumor thrombosis. MATERIALS AND METHODS: This study involved a total of 54 patients with hepatocellular carcinoma in whom hepatic arteriography revealed severe arterioportal shunt. From among this total, 34 patients (embolization group) underwent chemoinfusion after shunt embolization, while 19 (control group) underwent chemoinfusion only. The embolic materials included PVA particles and/or Gelfoam pieces. The frequency of postembolization symptoms (Chi-squared test) and changes in laboratory values (paired t-test) were compared between the two groups, and shunt improvement was also evaluated. Patient survival was tested using the Kaplan-Meier method. RESULTS: Fever and RUQ pain were more frequent in the embolization group (p<0.001). The complications of embolization included severe postembolization syndrome (n=1), acute hepatic failure (n=2), hepatic infarction (n=1), and sepsis (n=1). There were no significant changes in laboratory values. Among the 28 patients (24 of embolization group and four of control group) who underwent follow-up angiography, arterioportal shunt became less severe or disappeared in ten of the embolization group. For the embolization and control groups, the mean survival interval was 29.5 +/-5.4 weeks and 10.3 +/-3.1 weeks (p=0.0002), respectively. The best results were seen in the PVA particle group (p=0.01). CONCLUSION: The embolization of severe arterioportal shunts is relatively safe and increases patient survival rate.
Subject(s)
Humans , Angiography , Carcinoma, Hepatocellular , Fever , Follow-Up Studies , Gelatin Sponge, Absorbable , Infarction , Liver Failure, Acute , Portal Vein , Sepsis , Survival Rate , ThrombosisABSTRACT
PURPOSE: To investigate the usefulness of evaluating liver cirrhosis through the measurement of liver volume. MATERIALS AND METHODS: In a control group(20 normal subjects) and 20 cirrhotic patients, variations in liver volume before and after a meal were obtained. A case-control study was conducted between the two groups. RESULTS: In the control group, the range of increased liver volume after the meal was 67-186ml. Mean increased liver volume was 119.3ml, the range of percentage increase was 6-12% and the mean percentage increase was 9.89%. In cirrhotic patients, the range of increased liver volume after the meal was 1-20ml. Mean increased liver volume was 6.9ml, the range of percentage increase was 0-1.9% and the mean percentage increase was 0.65%. Compared with the control group, cirrhotic patients showed a much smaller increase in liver volume (p<0.01). CONCLUSION: Difference in variation of liver volume between a control group and cirrhotic patients before and after a meal can be used for the evaluation of liver cirrhosis.