Nodular Regenerative Hyperplasia Is Not a Rare Condition After Liver Transplantation: Incidence, Predictive Factors, and Impact on Survival

Kounis, Ilias; Sebagh, Mylène; Evain, Manon; Cailliez, Valérie; Roche, Bruno; Martin, Eléonora De; Sobesky, Rodolphe; Guettier, Catherine; Allard, Marc Antoine; Golse, Nicolas; Azoulay, Daniel; Vibert, Éric; Vallee, J.C. Duclos; Féray, Cyrille; Samuel, Didier; Coilly, Audrey

doi:10.1097/tp.0000000000004303

Cited by 9 publications

(8 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of the 87 full-text studies reviewed, 29 were included for data extraction. These included 17 studies pertaining to NRH in the native liver resulting in liver transplant or listing for liver transplant (6,7,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), and 11 studies pertaining to the development of NRH after liver transplantation (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40).…”

Section: Search Resultsmentioning

confidence: 99%

“…The mean incidence of NRH among liver transplant recipients was 2.9% ( Tables 2 , 3 ) ( 32 , 34 , 36 , 38 – 40 ). Timing of NRH development was highly variable, and NRH was often discovered on protocol surveillance biopsies post-transplant in asymptomatic patients ( 33 , 36 , 40 ). For patients with NRH, those who were asymptomatic ranged anywhere from 34%–91%.…”

Section: Resultsmentioning

confidence: 99%

“…There are reports of intervening on vascular abnormalities, with variable follow-up as to the persistence or resolution of NRH ( 33 , 38 , 39 ). Some patients required endovascular or surgical portocaval shunts for the treatment of portal hypertension ( 40 ). Of studies with larger cohorts of patients, graft failure ranged anywhere from 6%–44% and patient survival ranged from 63%–93% ( 30 , 33 , 34 , 36 , 39 , 40 ).…”

Section: Resultsmentioning

confidence: 99%

“…Some patients required endovascular or surgical portocaval shunts for the treatment of portal hypertension ( 40 ). Of studies with larger cohorts of patients, graft failure ranged anywhere from 6%–44% and patient survival ranged from 63%–93% ( 30 , 33 , 34 , 36 , 39 , 40 ).…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Nodular regenerative hyperplasia and liver transplantation: a systematic review

Biesterveld,

Schroder,

Hitchcock

et al. 2023

Front. Transplant.

View full text Add to dashboard Cite

Nodular regenerative hyperplasia (NRH) is a primary disease of the liver that may cause noncirrhotic portal hypertension. Common causes include autoimmune, hematologic, immune deficiency, and myeloproliferative disorders. Given the limited data regarding the development of NRH in contemporary immunosuppressive protocols and the occurrence of NRH post-liver transplantation, we systematically reviewed NRH as it pertains to liver transplantation. We performed a comprehensive search for NRH and transplantation. Nineteen studies were identified with relevant data for NRH as an indication for a liver transplant. Thirteen studies were identified with relevant data pertaining to NRH development after liver transplant. Pooled analysis revealed 0.9% of liver transplant recipients had NRH. A total of 113 patients identified with NRH underwent liver transplantation. Most series report transplants done after the failure of endoscopic banding and TIPS management of portal hypertension. Reported 5-year graft and patient survival ranged from 73%–78% and 73%–90%. The pooled incidence of NRH after liver transplant for all indications was 2.9% and caused complications of portal hypertension. Complications related to portal hypertension secondary to NRH are a rare indication for a liver transplant. NRH can develop at any time after liver transplantation often without an identifiable cause, which may lead to portal hypertension requiring treatment or even re-transplantation.

show abstract

Section: Search Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Nodular regenerative hyperplasia and liver transplantation: a systematic review

Biesterveld,

Schroder,

Hitchcock

et al. 2023

Front. Transplant.

View full text Add to dashboard Cite

show abstract

“…In our cohort, patient #5 showed a good response to anti-TNFa treatment on granuloma formation, however, overall liver disease progressed. Outcome data after liver transplantation are also variable, with the re-occurrence of NRH-LC in the transplanted organ in CVID patients (45)(46)(47)(48) as well as in patients without inborn errors of immunity (49). Despite the elevated morbidity of CVID patients with non-cirrhotic PH, liver transplantation remains a challenging option.…”

Section: A B D Cmentioning

confidence: 99%

Portal hypertension in common variable immunodeficiency disorders – a single center analysis on clinical and immunological parameter in 196 patients

Hanitsch,

Steiner,

Schumann

et al. 2023

Front. Immunol.

View full text Add to dashboard Cite

BackgroundLiver manifestations and in particular portal hypertension (PH) contribute significantly to morbidity and mortality of patients with common variable immunodeficiency disorders (CVID). Screening strategies and early detection are limited due to the lack of specific diagnostic tools.MethodsWe evaluated clinical, immunological, histological, and imaging parameters in CVID patients with clinical manifestation of portal hypertension (CVID+PH).ResultsPortal hypertension was present in 5.6% of CVID patients and was associated with high clinical burden and increased mortality (18%). Longitudinal data on clinical and immunological parameters in patients before and during clinically manifest portal hypertension revealed a growing splenomegaly and increasing gamma-glutamyl transferase (GGT) and soluble interleukin 2 receptor (SIL-2R) levels with decreasing platelets over time. While ultrasound of the liver failed to detect signs of portal hypertension in most affected patients, transient elastography was elevated in all patients. All CVID+PH patients had reduced naïve CD45RA+CD4+ T-cells (mean of 6,2%). The frequency of severe B-lymphocytopenia (Euroclass B-) was higher in CVID+PH patients. The main histological findings included lymphocytic infiltration, nodular regenerative hyperplasia-like changes (NRH-LC), and porto(-septal) fibrosis.ConclusionCVID patients with lower naïve CD45RA+CD4+ T-cells or severely reduced B-cells might be at higher risk for portal hypertension. The combination of biochemical (increasing sIL-2R, GGT, and decreasing platelets) and imaging parameters (increasing splenomegaly) should raise suspicion of the beginning of portal hypertension.

show abstract

Nodular Regenerative Hyperplasia: Report of 82 Patients and Systematic Review of Literature

Kaze,

Baldin,

Piessevaux

et al. 2024

UEG Journal

View full text Add to dashboard Cite

BackgroundData about the clinical significance and outcome of patients with nodular regenerative hyperplasia are limited.ObjectiveThe aim of this study was to describe the clinical and histopathological characteristics of patients with nodular regenerative hyperplasia and compare our findings with the literature.MethodsFrom January 2015 to March 2021, patients with a diagnosis of nodular regenerative hyperplasia were included. They were extracted from the database of the pathology department of Cliniques universitaires Saint‐Luc. Clinical and histological data were retrospectively recorded and complications of portal hypertension and mortality were analyzed. We also performed a systematic review of the literature.ResultsEighty‐two histology‐proven nodular regenerative hyperplasia were included. The mean age at diagnosis was 58 ± 14 years. At least one clinical sign of portal hypertension was present in 37 patients (45%), and liver tissue sampling was performed for 29 of them for evaluation of portal hypertension. Conversely, nodular regenerative hyperplasia was an incidental discovery in 27 patients (33%), mostly after liver resection for metastasis (n = 15) or protocol biopsy in liver‐transplanted patients (n = 9). The 5‐year liver‐related mortality was 5%. The 5‐year non‐liver‐related mortality was 20%. Patients diagnosed by clinical suspicion (n = 55) were compared to patients diagnosed incidentally (n = 27). Patients with an incidental diagnosis had more frequently a condition associated with nodular regenerative hyperplasia than patients diagnosed clinically (93% vs. 66%, p = 0.008) and they developed significantly lower liver‐related complications (4% vs. 27%, p = 0.01). A systematic review allowed us to compare our patients with 10 case series in the literature.ConclusionThe clinical spectrum of patients with nodular regenerative hyperplasia is heterogeneous, including patients with clinical liver manifestations and patients diagnosed incidentally who could remain free of liver‐related complications. This suggests that nodular regenerative hyperplasia could be a histological epiphenomenon as well as a clinical entity.

show abstract

Nodular Regenerative Hyperplasia Is Not a Rare Condition After Liver Transplantation: Incidence, Predictive Factors, and Impact on Survival

Cited by 9 publications

References 58 publications

Nodular regenerative hyperplasia and liver transplantation: a systematic review

Nodular regenerative hyperplasia and liver transplantation: a systematic review

Portal hypertension in common variable immunodeficiency disorders – a single center analysis on clinical and immunological parameter in 196 patients

Nodular Regenerative Hyperplasia: Report of 82 Patients and Systematic Review of Literature

Contact Info

Product

Resources

About