title: Hepatic hemodynamics in 24 patients with nodular regenerative hyperplasia and symptomatic portal hypertension.
abstract: OBJECTIVE
  To evaluate hepatic hemodynamics in patients with nodular regenerative hyperplasia of the liver (NRH) with portal hypertension (PHT).
  
  
  METHODS
  We retrospectively reviewed the charts of 24 patients referred for PHT related to biopsy-proven NRH. Hemodynamic measurements included wedged hepatic vein (WHVP) and inferior vena cava (IVCP), and, in 12 patients, portal vein pressure (PVP). Hepatic vein pressure gradient (HVPG: WHVP-IVCP) and portal vein pressure gradient (PVPG: PVP-IVCP) were calculated.
  
  
  RESULTS
  Nodular regenerative hyperplasia was associated in 24 patients with various diseases (oxaliplatin chemotherapy, treatment with purine antagonists, post liver transplantation, hematologic and rheumatologic conditions and HIV infection). Liver function parameters were either completely normal or slightly impaired. Patients were referred for gastroesophageal varices (n = 18), and/or ascites (n = 11), and/or splenomegaly (n = 20). In patients with varices or ascites, HVPG was lower than 10 mmHg (a cut-off point for the presence of varices and/or ascites) in 15/21, suggesting a pre-sinusoidal component to their PHT confirmed by a PVP higher than 12 mmHg in 12/12 patients. The mean difference between HVPG and PVPG was 8.7 mmHg in these patients. Ten patients were treated by transjugular intrahepatic portosystemic shunt. None of them re-bled, and one presented transient hepatic encephalopathy.
  
  
  CONCLUSIONS
  Presinusoidal PHT associated with NRH is probably related to compression of portal venules by the regenerative nodules. In patients with HTP and a HVPG < 10 mmHg, the diagnosis of NRH must be suspected and PVP measured, which is important in the management of these patients.
authors.affiliation: Liver Unit, CHUM St-Luc, Montréal, Canada.
authors.forename: Julien
authors.initials: J
authors.lastname: Bissonnette
authors.forename: Alexandre
authors.initials: A
authors.lastname: Généreux
authors.forename: Jean
authors.initials: J
authors.lastname: Côté
authors.forename: Bich
authors.initials: B
authors.lastname: Nguyen
authors.forename: Pierre
authors.initials: P
authors.lastname: Perreault
authors.forename: Louis
authors.initials: L
authors.lastname: Bouchard
authors.forename: Gilles
authors.initials: G
authors.lastname: Pomier-Layrargues
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis / Q000503:physiopathology*; D006439:Hemodynamics; D006503:Hepatic Veins / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D008099:Liver / Q000098:blood supply*; D008102:Liver Circulation; D008111:Liver Function Tests; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011169:Portal Vein / Q000503:physiopathology; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014682:Vena Cava, Inferior / Q000503:physiopathology; D014690:Venous Pressure