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DOI: 10.1055/s-0038-1629893
Measurement of Portal Pressure and its Application in the Clinical Setting
Publikationsverlauf
27. September 2017
03. Januar 2018
Publikationsdatum:
09. Februar 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00032260/201704/lookinside/thumbnails/10-1055-s-0038-1629893_1700031-1.jpg)
Abstract
Portal hypertension is a severe, yet common sequela of patients with chronic liver disease and is responsible for many of the complications seen in this population. Measurement of the hepatic venous pressure gradient (HVPG) is the current gold standard technique for identifying and evaluating the severity of portal hypertension. Any increase in HVPG to ≥10 mm Hg is considered clinically significant portal hypertension. Above this threshold, complications of portal hypertension begin to manifest. In addition to assessing portal hypertension, various HVPG thresholds have been shown to have strong prognostic value for risk of complications and therapeutic failure, as well as survival in patients with chronic liver disease. These clinical applications include quantification of disease progression and regression in chronic viral hepatitis, acute alcoholic hepatitis, and hepatocellular carcinoma. Other applications include preoperative evaluation of liver resection and transplantation in patients with cirrhosis and hepatocellular carcinoma, assessment of response to therapy for portal hypertension, and identification of the need for transjugular intrahepatic portosystemic shunt (TIPS) revision.
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References
- 1 Bosch J, Abraldes JG, Berzigotti A, García-Pagan JC. The clinical use of HVPG measurements in chronic liver disease. Nat Rev Gastroenterol Hepatol 2009; 6 (10) 573-582
- 2 Abraldes JG, Sarlieve P, Tandon P. Measurement of portal pressure. Clin Liver Dis 2014; 18 (Issue 4): 779-792
- 3 Leung JC, Loong TC, Pang J, Wei JL, Wong VW. Invasive and non-invasive assessment of portal hypertension. Hepatol Int 2017; ( e-pub ahead of print) DOI: 10.1007/s12072-017-9795-0.
- 4 Suk KT. Hepatic venous pressure gradient: clinical use in chronic liver disease. Clin Mol Hepatol 2014; 20 (01) 6-14
- 5 Sanyal AJ, Bosch J, Blei A, Arroyo V. Portal hypertension and its complications. Gastroenterology 2008; 134 (06) 1715-1728
- 6 Groszmann RJ, Wongcharatrawee S. The hepatic venous pressure gradient: anything worth doing should be done right. Hepatology 2004; 39 (02) 280-282
- 7 Perelló A, Escorsell A, Bru C. , et al. Wedged hepatic venous pressure adequately reflects portal pressure in hepatitis C virus-related cirrhosis. Hepatology 1999; 30 (06) 1393-1397
- 8 Boyer TD, Triger DR, Horisawa M, Redeker AG, Reynolds TB. Direct transhepatic measurement of portal vein pressure using a thin needle. Comparison with wedged hepatic vein pressure. Gastroenterology 1977; 72 (4 Pt 1): 584-589
- 9 Pomier-Layrargues G, Kusielewicz D, Willems B. , et al. Presinusoidal portal hypertension in non-alcoholic cirrhosis. Hepatology 1985; 5 (03) 415-418
- 10 Lin HC, Tsai YT, Lee FY. , et al. Comparison between portal vein pressure and wedged hepatic vein pressure in hepatitis B-related cirrhosis. J Hepatol 1989; 9 (03) 326-330
- 11 Thalheimer U, Leandro G, Samonakis DN, Triantos CK, Patch D, Burroughs AK. Assessment of the agreement between wedge hepatic vein pressure and portal vein pressure in cirrhotic patients. Dig Liver Dis 2005; 37 (08) 601-608
- 12 Steinlauf AF, Garcia-Tsao G, Zakko MF, Dickey K, Gupta T, Groszmann RJ. Low-dose midazolam sedation: an option for patients undergoing serial hepatic venous pressure measurements. Hepatology 1999; 29 (04) 1070-1073
- 13 La Mura V, Abraldes JG, Berzigotti A. , et al. Right atrial pressure is not adequate to calculate portal pressure gradient in cirrhosis: a clinical-hemodynamic correlation study. Hepatology 2010; 51 (06) 2108-2116
- 14 Maleux G, Willems E, Fieuws S. , et al. Prospective study comparing different indirect methods to measure portal pressure. J Vasc Interv Radiol 2011; 22 (11) 1553-1558
- 15 Zipprich A, Winkler M, Seufferlein T, Dollinger MM. Comparison of balloon vs. straight catheter for the measurement of portal hypertension. Aliment Pharmacol Ther 2010; 32 (11-12): 1351-1356
- 16 Thabut D, Moreau R, Lebrec D. Noninvasive assessment of portal hypertension in patients with cirrhosis. Hepatology 2011; 53 (02) 683-694
- 17 McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med 2003; 348 (12) 1123-1133
- 18 Valla DC, Condat B. Portal vein thrombosis in adults: pathophysiology, pathogenesis and management. J Hepatol 2000; 32 (05) 865-871
- 19 Gluud C, Brok J, Gong Y, Koretz RL. Hepatology may have problems with putative surrogate outcome measures. J Hepatol 2007; 46 (04) 734-742
- 20 Procopet B, Berzigotti A. Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy. Gastroenterol Rep (Oxf) 2017; 5 (02) 79-89
- 21 Silva-Junior G, Baiges A, Turon F. , et al. The prognostic value of hepatic venous pressure gradient in patients with cirrhosis is highly dependent on the accuracy of the technique. Hepatology 2015; 62 (05) 1584-1592
- 22 Berzigotti A, Seijo S, Reverter E, Bosch J. Assessing portal hypertension in liver diseases. Expert Rev Gastroenterol Hepatol 2013; 7 (02) 141-155
- 23 Burroughs AK, Groszmann R, Bosch J. , et al. Assessment of therapeutic benefit of antiviral therapy in chronic hepatitis C: is hepatic venous pressure gradient a better end point?. Gut 2002; 50 (03) 425-427
- 24 Kumar M, Kumar A, Hissar S. , et al. Hepatic venous pressure gradient as a predictor of fibrosis in chronic liver disease because of hepatitis B virus. Liver Int 2008; 28 (05) 690-698
- 25 Vincent JK, Stark C, Shields JT, Bhave AD, Morris CS. Hepatic venous pressure gradient correlates with advanced hepatic fibrosis: a retrospective review. Abdom Radiol (NY) 2017; 42 (11) 2609-2614
- 26 Rincon D, Ripoll C, Lo Iacono O. , et al. Antiviral therapy decreases hepatic venous pressure gradient in patients with chronic hepatitis C and advanced fibrosis. Am J Gastroenterol 2006; 101 (10) 2269-2274
- 27 Roberts S, Gordon A, McLean C. , et al. Effect of sustained viral response on hepatic venous pressure gradient in hepatitis C-related cirrhosis. Clin Gastroenterol Hepatol 2007; 5 (08) 932-937
- 28 Reiberger T, Rutter K, Ferlitsch A. , et al. Portal pressure predicts outcome and safety of antiviral therapy in cirrhotic patients with hepatitis C virus infection. Clin Gastroenterol Hepatol 2011; 9 (07) 602-8.e1
- 29 Afdhal N, Everson GT, Calleja JL. , et al. Effect of viral suppression on hepatic venous pressure gradient in hepatitis C with cirrhosis and portal hypertension. J Viral Hepat 2017; 24 (10) 823-831
- 30 Rehm J, Samokhvalov AV, Shield KD. Global burden of alcoholic liver diseases. J Hepatol 2013; 59 (01) 160-168
- 31 Poynard T, Degott C, Munoz C, Lebrec D. Relationship between degree of portal hypertension and liver histologic lesions in patients with alcoholic cirrhosis. Effect of acute alcoholic hepatitis on portal hypertension. Dig Dis Sci 1987; 32 (04) 337-343
- 32 Sen S, Mookerjee RP, Cheshire LM, Davies NA, Williams R, Jalan R. Albumin dialysis reduces portal pressure acutely in patients with severe alcoholic hepatitis. J Hepatol 2005; 43 (01) 142-148
- 33 Rincon D, Lo Iacono O, Ripoll C. , et al. Prognostic value of hepatic venous pressure gradient for in-hospital mortality of patients with severe acute alcoholic hepatitis. Aliment Pharmacol Ther 2007; 25 (07) 841-848
- 34 Altamirano J, Miquel R, Katoonizadeh A. , et al. A histologic scoring system for prognosis of patients with alcoholic hepatitis. Gastroenterology 2014; 146 (05) 1231-9.e1 , 6
- 35 Ripoll C, Bañares R, Rincón D. , et al. Influence of hepatic venous pressure gradient on the prediction of survival of patients with cirrhosis in the MELD Era. Hepatology 2005; 42 (04) 793-801
- 36 Kim TY, Lee JG, Sohn JH. , et al. Hepatic venous pressure gradient predicts long-term mortality in patients with decompensated cirrhosis. Yonsei Med J 2016; 57 (01) 138-145
- 37 Blasco A, Forns X, Carrión JA. , et al. Hepatic venous pressure gradient identifies patients at risk of severe hepatitis C recurrence after liver transplantation. Hepatology 2006; 43 (03) 492-499
- 38 Samonakis DN, Cholongitas E, Thalheimer U. , et al. Hepatic venous pressure gradient to assess fibrosis and its progression after liver transplantation for HCV cirrhosis. Liver Transpl 2007; 13 (09) 1305-1311
- 39 Carrión JA, Navasa M, García-Retortillo M. , et al. Efficacy of antiviral therapy on hepatitis C recurrence after liver transplantation: a randomized controlled study. Gastroenterology 2007; 132 (05) 1746-1756
- 40 Ripoll C, Groszmann RJ, Garcia-Tsao G. , et al; Portal Hypertension Collaborative Group. Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol 2009; 50 (05) 923-928
- 41 Forner A, Bruix J. East meets the West--portal pressure predicts outcome of surgical resection for hepatocellular carcinoma. Nat Clin Pract Gastroenterol Hepatol 2009; 6 (01) 14-15
- 42 Qi X, Zhang X, Li Z. , et al. HVPG signature: a prognostic and predictive tool in hepatocellular carcinoma. Oncotarget 2016; 7 (38) 62789-62796
- 43 European Association For The Study Of The Liver; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56 (04) 908-943
- 44 Bruix J, Sherman M. ; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53 (03) 1020-1022
- 45 Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 1999; 30 (06) 1434-1440
- 46 Bruix J, Castells A, Bosch J. , et al. Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology 1996; 111 (04) 1018-1022
- 47 He W, Zeng Q, Zheng Y. , et al. The role of clinically significant portal hypertension in hepatic resection for hepatocellular carcinoma patients: a propensity score matching analysis. BMC Cancer 2015; 15: 263
- 48 Cucchetti A, Cescon M, Golfieri R. , et al. Hepatic venous pressure gradient in the preoperative assessment of patients with resectable hepatocellular carcinoma. J Hepatol 2016; 64 (01) 79-86
- 49 Zhong JH, Li LQ. Portal hypertension should not be a contraindication of hepatic resection to treat hepatocellular carcinoma with compensated cirrhosis. Hepatology 2015; 62 (03) 977-978
- 50 Yang T, Lau WY, Zhang H, Wu M, Shen F. Should surgery be carried out in patients with hepatocellular carcinoma with portal hypertension?. Hepatology 2015; 62 (03) 976
- 51 Zhong JH, Li H, Xiao N. , et al. Hepatic resection is safe and effective for patients with hepatocellular carcinoma and portal hypertension. PLoS One 2014; 9 (09) e108755
- 52 Garcia-Tsao G, Groszmann RJ, Fisher RL, Conn HO, Atterbury CE, Glickman M. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology 1985; 5 (03) 419-424
- 53 Casado M, Bosch J, García-Pagán JC. , et al. Clinical events after transjugular intrahepatic portosystemic shunt: correlation with hemodynamic findings. Gastroenterology 1998; 114 (06) 1296-1303
- 54 Addley J, Tham TC, Cash WJ. Use of portal pressure studies in the management of variceal haemorrhage. World J Gastrointest Endosc 2012; 4 (07) 281-289
- 55 Groszmann RJ, Bosch J, Grace ND. , et al. Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage. Gastroenterology 1990; 99 (05) 1401-1407
- 56 Feu F, García-Pagán JC, Bosch J. , et al. Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhage in patients with cirrhosis. Lancet 1995; 346 (8982): 1056-1059
- 57 Abraldes JG, Tarantino I, Turnes J, Garcia-Pagan JC, Rodés J, Bosch J. Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatology 2003; 37 (04) 902-908
- 58 Abraldes JG, Villanueva C, Bañares R. , et al; Spanish Cooperative Group for Portal Hypertension and Variceal Bleeding. Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy. J Hepatol 2008; 48 (02) 229-236
- 59 Albillos A, Bañares R, González M. , et al. Value of the hepatic venous pressure gradient to monitor drug therapy for portal hypertension: a meta-analysis. Am J Gastroenterol 2007; 102 (05) 1116-1126
- 60 D'Amico G, Garcia-Pagan JC, Luca A, Bosch J. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review. Gastroenterology 2006; 131 (05) 1611-1624
- 61 Villanueva C, Aracil C, Colomo A. , et al. Acute hemodynamic response to beta-blockers and prediction of long-term outcome in primary prophylaxis of variceal bleeding. Gastroenterology 2009; 137 (01) 119-128
- 62 Bureau C, Péron JM, Alric L. , et al. “A La Carte” treatment of portal hypertension: Adapting medical therapy to hemodynamic response for the prevention of bleeding. Hepatology 2002; 36 (06) 1361-1366
- 63 Burroughs AK, Vangeli M. Transjugular intrahepatic portosystemic shunt versus endoscopic therapy: randomized trials for secondary prophylaxis of variceal bleeding: an updated meta-analysis. Scand J Gastroenterol 2002; 37 (03) 249-252
- 64 Garcia-Tsao G. Transjugular intrahepatic portosystemic shunt in the management of refractory ascites. Semin Intervent Radiol 2005; 22 (04) 278-286
- 65 Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. ; Practice Guidelines Committee of the American Association for the Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46 (03) 922-938
- 66 Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017; 65 (01) 310-335
- 67 de Franchis R. ; Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63 (03) 743-752