title: Different hemodynamic patterns of alcoholic and viral endstage cirrhosis: analysis of explanted liver weight, degree of fibrosis and splanchnic Doppler parameters.
abstract: 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.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Padua, Italy. massimo.bolognesi@unipd.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Bolognesi
authors.forename: David
authors.initials: D
authors.lastname: Sacerdoti
authors.forename: Claudia
authors.initials: C
authors.lastname: Mescoli
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Bombonato
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Roberto
authors.initials: R
authors.lastname: Merenda
authors.forename: Luciano
authors.initials: L
authors.lastname: Giacomelli
authors.forename: Carlo
authors.initials: C
authors.lastname: Merkel
authors.forename: Massimo
authors.initials: M
authors.lastname: Rugge
authors.forename: Angelo
authors.initials: A
authors.lastname: Gatta
mesh_terms: 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