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Splenic non-infarction volume determines a clinically significant hepatic venous pressure gradient response to partial splenic embolization in patients with cirrhosis and hypersplenism

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

This study aimed to investigate changes in the hepatic venous pressure gradient (HVPG) by partial splenic embolization (PSE) and to identify the determinants of a clinically meaningful postoperative HVPG reduction.

Methods

Sixty-eight patients with cirrhosis and hypersplenism who underwent PSE at our department between September 2007 and June 2020 were included. The HVPG was evaluated pre- and immediately post-PSE. The patients were divided into three groups according to their preprocedural HVPG: low-HVPG (< 10 mmHg, n = 22), intermediate-HVPG (10 mmHg ≤ HVPG < 16 mmHg, n = 33), and high-HVPG (≥ 16 mmHg, n = 13).

Results

Overall, PSE significantly reduced HVPG from 12.2 ± 4.0 to 9.4 ± 3.6 mmHg (p < 0.01) with a relative decrease of 22.2 ± 20.4%. In addition, HVPG reductions were 19.4 ± 28.7%, 24.0 ± 15.9%, and 22.5 ± 13.3% in the low-, intermediate-, and high-HVPG groups, respectively, indicating no significant difference in HVPG reduction between the groups. An HVPG decrease of ≥ 20% from the baseline, defined in this study as a clinically significant HVPG response to PSE, was achieved in 55.9% of all patients. Multivariate logistic regression and receiver operating characteristic curve analyses identified splenic non-infarction volume as an independent determinant of a 20% decrease in HVPG (p < 0.05), with a cut-off of 139.2 cm3 (sensitivity, 76.3%; specificity, 60.0%; p < 0.05).

Conclusions

The splenic non-infarction volume, namely the residual functional spleen volume, independently determines a clinically significant HVPG response to PSE in patients with cirrhosis and hypersplenism.

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Acknowledgements

We would like to thank Editage (www.editage.jp) for English language editing.

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The authors declare that they have no financial support concerning this article.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube-Yamaguchi, 7558505, Japan

    Tsuyoshi Ishikawa, Ryo Sasaki, Tatsuro Nishimura, Takashi Matsuda, Takuya Iwamoto, Issei Saeki, Isao Hidaka, Taro Takami & Isao Sakaida

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  1. Tsuyoshi Ishikawa
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  2. Ryo Sasaki
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  3. Tatsuro Nishimura
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Contributions

Conceptualization: TI. Methodology: TI. Data collection: TI, RS, TN, TM, TI, IS, and IH. Formal analysis and investigation: TI. Writing-original draft preparation: TI. Writing-review and editing: RS, TM, TI, and TT. Supervision: IS.

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Correspondence to Tsuyoshi Ishikawa.

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Ishikawa, T., Sasaki, R., Nishimura, T. et al. Splenic non-infarction volume determines a clinically significant hepatic venous pressure gradient response to partial splenic embolization in patients with cirrhosis and hypersplenism. J Gastroenterol 56, 382–394 (2021). https://doi.org/10.1007/s00535-021-01762-7

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  • DOI: https://doi.org/10.1007/s00535-021-01762-7

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