Histological-hemodynamic correlation in cirrhosis—a histological classification of the severity of cirrhosis

Nagula, Satish; Jain, Dhanpat; Groszmann, Roberto J.; García–Tsao, Guadalupe

doi:10.1016/j.jhep.2005.07.036

Cited by 228 publications

(179 citation statements)

References 17 publications

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“…There were 25 pressure evaluations (18 patients) that fulfilled our definition of potentially discrepant results with respect to the expected fibrosis stage or HVPG. The median biopsy length of the entire "discrepant" group was 22 mm (range, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] and the number of fragments was 3.5 (range, 2-8) similar to the population as a whole. In the discrepant group, 56% of biopsies did not show severe nodularity/cirrhosis with 4 (range, 1-9) complete portal tracts and 8 (range, 2-13) partial portal tracts.…”

Section: Total Cohortmentioning

confidence: 85%

“…Recently, in 23 alcoholic-related and 25 HCV-related patients with cirrhosis, HVPG correlated with small nodularity and increasing thickness of fibrous septae. 15 Given that progression of fibrosis at different sites of the liver may be heterogeneous, the average pressure measured over a large area of stagnant flow (by occlusion of the balloon) may reflect fibrosis better than the comparatively small area analyzed by liver biopsy 17 ; this means that HVPG may be a better measure to assess in repeated evaluations, as the error may be less than assessing changes in fibrosis stage.…”

Section: Discussionmentioning

confidence: 99%

“…HVPG measurement can give additional information to the liver biopsy 39 after LT for HCV cirrhosis, which may also be useful in the nontransplantation situation. 2,3,7,[15][16][17]40 …”

Section: Discussionmentioning

confidence: 99%

“…12 A significant correlation has been shown between antiviral response and HVPG changes in HCV chronic hepatitis, 13,14 and between HVPG and histological features of cirrhosis. 15 HVPG Ͼ10 mmHg predicts the development of complications of HCV cirrhosis. 16 HVPG has been put forward as a test that would reflect progression during both precirrhotic and cirrhotic stages of HCV liver disease and be an end point in antiviral therapy, irrespective of antiviral response.…”

mentioning

confidence: 99%

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Hepatic venous pressure gradient to assess fibrosis and its progression after liver transplantation for HCV cirrhosis

et al. 2007

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Progression of fibrosis following recurrent hepatitis C virus (HCV) infection is frequent after liver transplantation (LT).Histology remains the gold standard to assess fibrosis, but the value of hepatic venous pressure gradient (HVPG) is being explored. We evaluated patients with recurrent HCV infection after LT to assess whether HVPG correlates with liver histology, particularly fibrosis. A total of 90 consecutive patients underwent 170 HVPG measurements concomitant with transjugular liver biopsy (TJB), with 31.5 (range, 6-156) months of follow up. Median biopsy length was 22 mm and total portal tract count was 12 (complete 6, partial 6). Median HVPG was 4 mmHg: 38% of patients Ն6 mmHg (portal hypertension, PHT), 13% Ն10 mmHg. HVPG correlated with Ishak stage (r ϭ 0.73, P Ͻ 0.001) for mild (0-3) and severe fibrosis (4-6), and grade score (r ϭ 0.47, P Ͻ 0.001), but neither correlated with interval from LT nor biopsy length. HVPG was Ն10 mmHg in 15 patients: 12 had stage 5 or 6, and 3 severe portal expansion. HVPG was repeated in 49, between 7 and 60 months with weak correlation to fibrosis score (r ϭ 0.30, P ϭ 0.045). A total of 12 patients with HVPG Ն6 mmHg had fibrosis score Յ3, while 8 patients had normal HVPG but fibrosis stage Ն4. These discrepancies were mostly associated with specific histological features such as perisinusoidal fibrosis rather than errors in measuring HVPG. In 29 with HVPG Ͻ6 mmHg at 1 yr, none decompensated compared to 4 of 13 (31%) with PHT. In conclusion, HVPG correlates with fibrosis and its progression, due to recurrent HCV infection, assessed in TJB. Liver Transpl 13:1305Transpl 13: -1311Transpl 13: , 2007 The severity of portal hypertension (PHT) correlates with the severity of liver disease and cirrhosis, both functionally and histologically 1 and also with the Model for End-Stage Liver Disease, 2 such that it has independent prognostic value separate from clinical and laboratory assessment. 2,3 Hepatic vein catheterisation 4 was modified by Groszmann et al. 5 using a balloon catheter. The measurement of hepatic venous pressure gradient (HVPG) (the difference between wedge hepatic venous pressure [WHVP] Ϫ free hepatic venous pressure) is reproducible 6 and is the preferred technique for evaluating PHT, correlating 1:1 with the direct measurement of portal vein pressure in patients with sinusoidal and postsinusoidal causes of cirrhosis, 7,8 particularly alcoholic and viral-related cirrhosis. Normally HVPG ranges from 1 to 5 mmHg; pressures Ն6 mmHg indicate PHT. 6 WHVP increases with progression of chronic hepatitis and PHT, before histologically detectable cirrhosis. 9 A gradient Ͼ5 mmHg was always associated with significant changes in liver biopsy in 1 study, although a normal gradient did not completely rule out cirrhosis, 10 suggesting that WHVP could provide supplementary information to liver biopsy, with a higher predictive value for assessing stage and activity of chronic liver disease, than routine biochemical tests. 10 Other studies have correlated HVPG both with severit...

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Section: Total Cohortmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

“…HVPG measurement can give additional information to the liver biopsy 39 after LT for HCV cirrhosis, which may also be useful in the nontransplantation situation. 2,3,7,[15][16][17]40 …”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Hepatic venous pressure gradient to assess fibrosis and its progression after liver transplantation for HCV cirrhosis

et al. 2007

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“…In these patients, a functional parameter that is correlated with the extent of remodeling and fibrosis, such as hepatic portal vein pressure gradient (HVPG) is plausible. 77 In fact, a recent study confirmed HVPG as the best predictor of mortality in cirrhotic patients with compensated Child's A cirrhosis. 78 Yet the shortcomings of traditional study design and technologies highlight the need for the identification of new biomarkers or imaging techniques that allow an exact assessment of the degree of fibrosis and, more important, of the dynamic processes of fibrogenesis or fibrolysis, in order to predict fibrosis progression or to monitor the effect of antifibrotic therapies.…”

Section: Noninvasive Means To Assess Liver Fibrosis and Fibrogenesismentioning

confidence: 94%

Targeting Liver Fibrosis

2009

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We have made striking progress in our understanding of the biochemistry and cell biology that underlies liver fibrosis and cirrhosis, including the development of strategies and agents to prevent and reverse fibrosis. However, translation of this knowledge into clinical practice has been hampered by (1) the limitation of many in vitro and in vivo models to confirm mechanisms and to test antifibrotic agents, and (2) the lack of sensitive methodologies to quantify the degree of liver fibrosis and the dynamics of fibrosis progression or reversal in patients. Furthermore, whereas cirrhosis and subsequent decompensation are accepted hard clinical endpoints, fibrosis and fibrosis progression alone are merely plausible surrogates for future clinical deterioration. In this review we focus on an optimized strategy for preclinical antifibrotic drug development and highlight the current and future techniques that permit noninvasive assessment and quantification of liver fibrosis and fibrogenesis. The availability of such noninvasive methodologies will serve as the pacemaker for the clinical development and validation of potent antifibrotic agents. (HEPATOLOGY 2009;50:1294-1306

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Pathogenesis of Portal Hypertension

Groszmann

Abraldes

2009

The Liver

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Histological-hemodynamic correlation in cirrhosis—a histological classification of the severity of cirrhosis

Cited by 228 publications

References 17 publications

Hepatic venous pressure gradient to assess fibrosis and its progression after liver transplantation for HCV cirrhosis

Hepatic venous pressure gradient to assess fibrosis and its progression after liver transplantation for HCV cirrhosis

Targeting Liver Fibrosis

Pathogenesis of Portal Hypertension

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