The independent prognostic value of perioperative hepatic venous pressure gradient measurements in patients with portal hypertension who underwent laparoscopic splenectomy plus esophagogastric devascularization.
Esophagogastric devascularization
Hepatic venous pressure gradient
Liver cirrhosis
Portal hypertension
Splenectomy
Journal
BMC gastroenterology
ISSN: 1471-230X
Titre abrégé: BMC Gastroenterol
Pays: England
ID NLM: 100968547
Informations de publication
Date de publication:
19 Oct 2024
19 Oct 2024
Historique:
received:
10
08
2024
accepted:
14
10
2024
medline:
20
10
2024
pubmed:
20
10
2024
entrez:
19
10
2024
Statut:
epublish
Résumé
Hepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing portal hypertension (PHT). Laparoscopic splenectomy plus esophagogastric devascularization (LSED) is an important surgery for treating PHT. However, the variation trend of HVPG after surgery is not clear. Moreover, whether HVPG can provide precise prognostic information for patients undergoing surgery remains to be further studied. This study aimed to investigate the independent prognostic value of HVPG in LSED. From January 2016 to March 2023, 135 patients with PHT underwent LSED at our hospital were retrospectively evaluated. We analyzed the correlations between clinical indicators and history of upper gastrointestinal bleeding (UGIB). Among them, 57 patients remeasured postoperative HVPG. We further investigated the postoperative alterations of HVPG and correlative factors, as well as the relationship between the HVPG and postoperative UGIB. In this study, we found that 94 patients with preoperative UGIB (16.27 ± 5.73 mmHg) had a higher baseline HVPG than the other 41 patients without (14.02 ± 5.90 mmHg) (p = 0.04). The mean postoperative HVPG significantly decreased (-3.57 ± 8.09 mmHg, p = 0.001) compared to the baseline, and 66% of patients (38/57) experienced a decreased HVPG-response after surgery. The baseline HVPG and preoperative CTP class B were associated with the decreased HVPG-response (p<0.05). Additionally, patients with postoperative HVPG decreased>20% from baseline exhibited better recurrent hemorrhage-free survival rates than those without (log-rank, p = 0.013). We found that LSED led to a significantly decreased HVPG, and patients with postoperative HVPG decreased >20% obtained better UGIB-free survival benefits than those without.
Sections du résumé
BACKGROUND
BACKGROUND
Hepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing portal hypertension (PHT). Laparoscopic splenectomy plus esophagogastric devascularization (LSED) is an important surgery for treating PHT. However, the variation trend of HVPG after surgery is not clear. Moreover, whether HVPG can provide precise prognostic information for patients undergoing surgery remains to be further studied. This study aimed to investigate the independent prognostic value of HVPG in LSED.
METHODS
METHODS
From January 2016 to March 2023, 135 patients with PHT underwent LSED at our hospital were retrospectively evaluated. We analyzed the correlations between clinical indicators and history of upper gastrointestinal bleeding (UGIB). Among them, 57 patients remeasured postoperative HVPG. We further investigated the postoperative alterations of HVPG and correlative factors, as well as the relationship between the HVPG and postoperative UGIB.
RESULTS
RESULTS
In this study, we found that 94 patients with preoperative UGIB (16.27 ± 5.73 mmHg) had a higher baseline HVPG than the other 41 patients without (14.02 ± 5.90 mmHg) (p = 0.04). The mean postoperative HVPG significantly decreased (-3.57 ± 8.09 mmHg, p = 0.001) compared to the baseline, and 66% of patients (38/57) experienced a decreased HVPG-response after surgery. The baseline HVPG and preoperative CTP class B were associated with the decreased HVPG-response (p<0.05). Additionally, patients with postoperative HVPG decreased>20% from baseline exhibited better recurrent hemorrhage-free survival rates than those without (log-rank, p = 0.013).
CONCLUSION
CONCLUSIONS
We found that LSED led to a significantly decreased HVPG, and patients with postoperative HVPG decreased >20% obtained better UGIB-free survival benefits than those without.
Identifiants
pubmed: 39427122
doi: 10.1186/s12876-024-03464-9
pii: 10.1186/s12876-024-03464-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
372Subventions
Organisme : the Key Research and Development Program of Shaanxi Province, China
ID : 2024SF-YBXM-113
Organisme : Youth Independent Innovation Science Foundation of Tangdu Hospital
ID : 2023CTDQN008
Organisme : the Innovation and Development Foundation of the Second Hospital Affiliated to Air Force Military Medical University
ID : 2017LCYJ003, 2019LCYJ005
Organisme : National Natural Science Foundation of Shanxi Province
ID : 2015JM8420
Organisme : Shaanxi Science and technology innovation Project
ID : 2015KTCL03-05
Informations de copyright
© 2024. The Author(s).
Références
Wang X, Lin SX, Tao J, Wei XQ, Liu YT, Chen YM, Wu B. Study of liver cirrhosis over ten consecutive years in Southern China. World J Gastroenterol. 2014;20(37):13546–55.
doi: 10.3748/wjg.v20.i37.13546
pubmed: 25309085
pmcid: 4188906
Hepatology, CSo. Gastroenterology CSo, Association CSoDEoCM: guidelines on the management of esophagogastric variceal bleeding in cirrhotic portal hypertension. J Practical Hepatol. 2023;26(02):305–18.
de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C. Baveno VII - renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959–74.
doi: 10.1016/j.jhep.2021.12.022
pubmed: 35120736
Lee E, Kim YJ, Goo DE, Yang SB, Kim HJ, Jang JY, Jeong SW. Comparison of hepatic venous pressure gradient and endoscopic grading of esophageal varices. World J Gastroenterol. 2016;22(11):3212–9.
doi: 10.3748/wjg.v22.i11.3212
pubmed: 27003998
pmcid: 4789996
Semmler G, Lens S, Meyer EL, Baiges A, Alvardo-Tapias E, Llop E, Tellez L, Schwabl P, Mauro E, Escudé L, et al. Non-invasive tests for clinically significant portal hypertension after HCV cure. J Hepatol. 2022;77(6):1573–85.
doi: 10.1016/j.jhep.2022.08.025
pubmed: 36063968
Hofer BS, Simbrunner B, Hartl L, Jachs M, Bauer DJM, Balcar L, Paternostro R, Schwabl P, Semmler G, Scheiner B, et al. Alcohol abstinence improves prognosis across all stages of Portal Hypertension in Alcohol-related cirrhosis. Clin Gastroenterol Hepatology: Official Clin Pract J Am Gastroenterological Association. 2023;21(9):2308–e23172307.
doi: 10.1016/j.cgh.2022.11.033
Lens S, Baiges A, Alvarado-Tapias E, E LL, Martinez J, Fortea JI, Ibáñez-Samaniego L, Mariño Z, Rodríguez-Tajes S, Gallego A, et al. Clinical outcome and hemodynamic changes following HCV eradication with oral antiviral therapy in patients with clinically significant portal hypertension. J Hepatol. 2020;73(6):1415–24.
doi: 10.1016/j.jhep.2020.05.050
pubmed: 32535060
Beijing Society of Portal Hypertension BMAPH E C, Liver D isease Committee of Chinese Research Hospital Association. Expert consensus on multidisciplinary diagnosis and treatment of cirrhotic portal hypertension(based on hepatic venous pressure gradient). J Clin Hepatol. 2021;37(9):2037–44.
Wang D, Zhang Z, Dong R, Lu J, Yin J. Laparoscopic splenectomy and esophagogastric devascularization combined with fast-track principles offers greater benefit for patients with portal hypertension. Wideochirurgia i inne Techniki Maloinwazyjne = Videosurgery Other Miniinvasive Techniques. 2022;17(2):326–37.
doi: 10.5114/wiitm.2021.112680
pubmed: 35707335
pmcid: 9186085
Zhu W, Wang X, Lv Y, Chen H, Chen X, Li X, Zhu S, Lin Z, Wang G. Comparison of long-term outcomes of splenectomy with periesophagogastric devascularization and transjugular intrahepatic portosystemic shunt in treating cirrhotic portal hypertension patients with recurrent variceal bleeding. Langenbeck’s Archives Surg. 2023;408(1):215.
doi: 10.1007/s00423-023-02933-1
Schwabl P, Seeland BA, Riedl F, Schubert TL, Königshofer P, Brusilovskaya K, Petrenko O, Hofer B, Schiefer A-I, Trauner M. Splenectomy ameliorates portal pressure and anemia in animal models of cirrhotic and non-cirrhotic portal hypertension. Adv Med Sci. 2022;67(1):154–62.
doi: 10.1016/j.advms.2022.02.005
pubmed: 35272246
Wang D, Chen X, Lv L, Yang T, Huang B, Cao Y, Lu J, Yin J. Laparoscopic splenectomy and devascularization for massive splenomegaly in portal hypertensive patients: a retrospective study of a single surgical team’s experience with 6-year follow-up data. Annals Translational Med. 2022;10(4):207.
doi: 10.21037/atm-22-502
Group (CHESS), CPHDaMS G, CSo MIICG, CCo CEII, HDCGCSo G. SaPH, Group CSoSFLaALD: Consensus on clinical application of hepatic venous pressure gradient in China(2018). J Practical Hepatol. 2019;22(3):321–32.
Thabut D, Bureau C, Layese R, Bourcier V, Hammouche M, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, et al. Validation of Baveno VI Criteria for Screening and Surveillance of Esophageal varices in patients with compensated cirrhosis and a sustained response to antiviral therapy. Gastroenterology. 2019;156(4):997–e10091005.
doi: 10.1053/j.gastro.2018.11.053
pubmed: 30768988
Tamaki N, Kurosaki M, Yasui Y, Mori N, Tsuji K, Hasebe C, Joko K, Akahane T, Furuta K, Kobashi H, et al. Change in fibrosis 4 Index as Predictor of High Risk of Incident Hepatocellular Carcinoma after eradication of Hepatitis C Virus. Clin Infect Diseases: Official Publication Infect Dis Soc Am. 2021;73(9):e3349–54.
doi: 10.1093/cid/ciaa1307
DuBrock HM, Krowka MJ, Krok K, Forde K, Mottram C, Scanlon P, Al-Naamani N, Patel M, McCormick A, Fallon MB, et al. Prevalence and impact of restrictive lung disease in liver transplant candidates. Liver Transplantation: Official Publication Am Association Study Liver Dis Int Liver Transplantation Soc. 2020;26(8):989–99.
doi: 10.1002/lt.25794
Kim JN, Sohn KM, Kim MY, Suk KT, Jeong SW, Jung HE, Lee SH, Kim SG, Jang JY, Kim YS, et al. Relationship between the hepatic venous pressure gradient and first variceal hemorrhage in patients with cirrhosis: a multicenter retrospective study in Korea. Clin Mol Hepatol. 2012;18(4):391–6.
doi: 10.3350/cmh.2012.18.4.391
pubmed: 23323255
pmcid: 3540376
Sharma P. Value of liver function tests in cirrhosis. J Clin Experimental Hepatol. 2022;12(3):948–64.
doi: 10.1016/j.jceh.2021.11.004
Kawanaka H, Akahoshi T, Kinjo N, Iguchi T, Ninomiya M, Yamashita YI, Ikegami T, Yoshizumi T, Shirabe K, Maehara Y. Effect of laparoscopic splenectomy on portal haemodynamics in patients with liver cirrhosis and portal hypertension. Br J Surg. 2014;101(12):1585–93.
doi: 10.1002/bjs.9622
pubmed: 25200126
Tang S, Huang Z, Jiang J, Gao J, Zhao C, Tai Y, Ma X, Zhang L, Ye Y, Gan C, et al. Celecoxib ameliorates liver cirrhosis via reducing inflammation and oxidative stress along spleen-liver axis in rats. Life Sci. 2021;272:119203.
doi: 10.1016/j.lfs.2021.119203
pubmed: 33577848
Zeng DB, Di L, Zhang RC, Guo QL, Duan BW, Jia CY, Chen F, Lin DD, Zang YJ, Lu SC. The Effect of Splenectomy on the Reversal of Cirrhosis: a Prospective Study. Gastroenterology research and practice 2019, 2019:5459427.
Elchaninov A, Vishnyakova P, Sukhikh G, Fatkhudinov T. Spleen: reparative regeneration and influence on liver. Life (Basel Switzerland). 2022;12(5):626–40.
pubmed: 35629294
Liang QS, Xie JG, Yu C, Feng Z, Ma J, Zhang Y, Wang D, Lu J, Zhuang R, Yin J. Splenectomy improves liver fibrosis via tumor necrosis factor superfamily 14 (LIGHT) through the JNK/TGF-β1 signaling pathway. Exp Mol Med. 2021;53(3):393–406.
doi: 10.1038/s12276-021-00574-2
pubmed: 33654222
pmcid: 8080781
Bauer D, Kozbial K, Schwabl P, Chromy D, Simbrunner B, Stättermayer AF, Pinter M, Steindl-Munda P, Trauner M, Ferenci P, et al. Angiopoietin 2 levels decrease after HCV-cure and reflect the evolution of portal hypertension. Dig Liver Disease: Official J Italian Soc Gastroenterol Italian Association Study Liver. 2022;54(9):1222–9.
doi: 10.1016/j.dld.2022.02.013
Chen H, Huang N, Tian H, Li J, Li B, Sun J, Zhang S, Zhang C, Zhao Y, Kong G, et al. Splenectomy provides protective effects against CLP-induced sepsis by reducing TRegs and PD-1/PD-L1 expression. Int J Biochem Cell Biol. 2021;136:105970.
doi: 10.1016/j.biocel.2021.105970
pubmed: 33774183
Maruoka R, Aoki N, Kido M, Iwamoto S, Nishiura H, Ikeda A, Chiba T, Watanabe N. Splenectomy prolongs the effects of corticosteroids in mouse models of autoimmune hepatitis. Gastroenterology. 2013;145(1):209–e220209.
doi: 10.1053/j.gastro.2013.03.011
pubmed: 23523671
Yamamoto N, Okano K, Oshima M, Akamoto S, Fujiwara M, Tani J, Miyoshi H, Yoneyama H, Masaki T, Suzuki Y. Laparoscopic splenectomy for patients with liver cirrhosis: improvement of liver function in patients with child-pugh class B. Surgery. 2015;158(6):1538–44.
doi: 10.1016/j.surg.2015.05.008
pubmed: 26070848
Hirakawa Y, Ogata T, Sasada T, Yamashita T, Itoh K, Tanaka H, Okuda K. Immunological consequences following splenectomy in patients with liver cirrhosis. Experimental Therapeutic Med. 2019;18(1):848–56.
Li L, Duan M, Chen W, Jiang A, Li X, Yang J, Li Z. The spleen in liver cirrhosis: revisiting an old enemy with novel targets. J Translational Med. 2017;15(1):111.
doi: 10.1186/s12967-017-1214-8
Pei Y, Chai S, Zhang Y, Zhang Z, Chen X, Zhang W. Benefits of splenectomy and curative treatments for patients with Hepatocellular Carcinoma and Portal Hypertension: a retrospective study. J Gastrointest Surgery: Official J Soc Surg Aliment Tract. 2019;23(11):2151–62.
doi: 10.1007/s11605-018-3981-9
Zhao S, Xu W, Xie YX, Chen WW, Zhao M. CXCR5(+) CD4(+) T cell subsets and their relationship to immune dysfunction in chronic hepatitis B-associated liver cirrhosis. J Gastroenterol Hepatol. 2020;35(4):689–95.
doi: 10.1111/jgh.14866
pubmed: 31519041
Al-Dury S, Waern J, Waldenström J, Alavanja M, Saed HH, Törnell A, Arabpour M, Wiktorin HG, Einarsdottir S, Ringlander J, et al. Impaired SARS-CoV-2-specific T-cell reactivity in patients with cirrhosis following mRNA COVID-19 vaccination. JHEP Reports: Innov Hepatol. 2022;4(7):100496.
doi: 10.1016/j.jhepr.2022.100496
Mandorfer M, Kozbial K, Schwabl P, Chromy D, Semmler G, Stättermayer AF, Pinter M, Hernández-Gea V, Fritzer-Szekeres M, Steindl-Munda P, et al. Changes in hepatic venous pressure gradient predict hepatic decompensation in patients who Achieved Sustained Virologic response to Interferon-Free Therapy. Hepatology (Baltimore MD). 2020;71(3):1023–36.
doi: 10.1002/hep.30885
pubmed: 31365764
Wieland D, Hofmann M, Thimme R. Overcoming CD8 + T-Cell exhaustion in viral Hepatitis: lessons from the mouse model and clinical perspectives. Dig Dis (Basel Switzerland). 2017;35(4):334–8.
doi: 10.1159/000456584