Natural history of major complications in hepatitis C virus-related cirrhosis evaluated by per-rectal portal scintigraphy.
OBJECTIVE
To examine the correlation between the porto-systemic hypertension evaluated by portal shunt index (PSI) and life-threatening complications, including hepatocellular carcinoma (HCC), liver failure (Child-Pugh stage progression), and esophagogastric varices.


METHODS
Two hundred and twelve consecutive subjects with HCV-related cirrhosis (LC-C) underwent per-rectal portal scintigraphy. They were allocated into three groups according to their PSI: group I, PSI< or =10%; group II, 10%<PSI<30%; and group III, 30%< or =PSI. Of these, selected 122 Child-Pugh stage A (Child A) subjects were included in analysis (a mean follow-up period of 5.9+/-5.4 years, range 6 mo-21 years).


RESULTS
No significant correlation between PSI and cumulative probability of HCC incidence was observed. Cumulative probability of Child A to B progression was tended to be higher in group III than in group I, and significantly higher in group III than in group II (62% vs 34%, 62% vs 37%; P = 0.060, <0.01; respectively). Cumulative probability of varices tended to be higher in group III than in group I (31% vs 12%, P = 0.090). On multivariate analyses, significant correlation between PSI and Child A to B progression was observed, and no significant correlation between PSI and HCC incidence or varices progression was observed.


CONCLUSIONS
Patients with LC-C of Child A will progress to Child B rapidly after their PSI reaches 30% or higher. PSI can be used to predict occult progressive porto-systemic shunting and liver failure non-invasively. It indicates that PSI may play an important role in follow-up of the porto-systemic hypertension gradient for outpatients with LC unlike hepatic venous catheterization.
Kawamura
Etsushi
E
Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abenoku, Osaka 545-8585, Japan. etsushi-k@med.osaka-cu.ac.jp
Habu
Daiki
D
Hayashi
Takehiro
T
Oe
Ai
A
Kotani
Jin
J
Ishizu
Hirotaka
H
Torii
Kenji
K
Kawabe
Joji
J
Fukushima
Wakaba
W
Tanaka
Takashi
T
Nishiguchi
Shuhei
S
Shiomi
Susumu
S
D006528:Carcinoma, Hepatocellular / Q000209:etiology*; D015331:Cohort Studies; D004932:Esophageal and Gastric Varices / Q000209:etiology*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008103:Liver Cirrhosis / Q000150:complications / Q000821:virology*; D017093:Liver Failure / Q000209:etiology*; D008113:Liver Neoplasms / Q000209:etiology*; D008137:Longitudinal Studies; D011168:Portal System / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D012189:Retrospective Studies