Different hemodynamic patterns of alcoholic and viral endstage cirrhosis: analysis of explanted liver weight, degree of fibrosis and splanchnic Doppler parameters.
OBJECTIVE
In cirrhosis, portal hemodynamics is usually considered independently of the disease etiology. The objective of this study was to investigate the role of the etiology of liver disease on the relationship between liver blood flow and liver pathology in endstage cirrhosis.


METHODS
Portal blood velocity and volume, congestion index of the portal vein, and hepatic and splenic pulsatility indices were evaluated with echo-Doppler in cirrhotic patients immediately before liver transplantation. When a patent paraumbilical vein was present, its blood flow was measured and effective portal liver perfusion was calculated as portal blood flow minus paraumbilical blood flow. The hemodynamic parameters were correlated with liver weight and the pattern of the liver fibrosis morphometrically assessed in explanted livers. A total of 131 patients with alcoholic or viral cirrhosis were included in the study.


RESULTS
In alcoholic cirrhosis, liver weight was higher than that in viral disease (1246+/-295 g versus 1070+/-254 g, p=0.001), portal liver perfusion per gram of liver tissue was lower (0.49+/-0.36 ml g(-1) min(-1) versus 0.85+/-0.56 ml g(-1) min(-1), p=0.004) and hepatic pulsatility indices were higher (1.45+/-0.31 versus 1.26+/-0.30, p=0.018). The degree of liver fibrosis was similar in alcoholic and viral cirrhosis (11.7+/-5.5% versus 11.0+/-4.4%, p=NS). An inverse relationship between liver weight and Child-Pugh score was disclosed in viral (p<0.001) but not in alcoholic disease.


CONCLUSIONS
A different hemodynamic pattern characterizes the advanced stage of cirrhosis of alcoholic and viral origin. A more severe alteration of intrahepatic portal perfusion, probably coexisting with a more severe hepatocyte dysfunction, and a higher liver weight can be detected in alcoholic cirrhosis.
Bolognesi
Massimo
M
Department of Clinical and Experimental Medicine, University of Padua, Italy. massimo.bolognesi@unipd.it
Sacerdoti
David
D
Mescoli
Claudia
C
Bombonato
Giancarlo
G
Cillo
Umberto
U
Merenda
Roberto
R
Giacomelli
Luciano
L
Merkel
Carlo
C
Rugge
Massimo
M
Gatta
Angelo
A
D000328:Adult; D001706:Biopsy; D001783:Blood Flow Velocity / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D006525:Hepatitis, Viral, Human / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D008104:Liver Cirrhosis, Alcoholic / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013152:Splanchnic Circulation / Q000502:physiology*; D013162:Splenic Vein / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018615:Ultrasonography, Doppler, Color