Reversed portal flow: Clinical influence on the long-term outcomes in cirrhosis.
OBJECTIVE
To elucidate the natural history and the longitudinal outcomes in cirrhotic patients with non-forward portal flow (NFPF).


METHODS
The present retrospective study consisted of 222 cirrhotic patients (120 males and 102 females; age, 61.7 ± 11.1 years). The portal hemodynamics were evaluated at baseline and during the observation period using both pulsed and color Doppler ultrasonography. The diameter (mm), flow direction, mean flow velocity (cm/s), and mean flow volume (mL/min) were assessed at the portal trunk, the splenic vein, the superior mesenteric vein, and the collateral vessels. The average values from 2 to 4 measurements were used for the data analysis. The portal flow direction was defined as follows: forward portal flow (FPF) for continuous hepatopetal flow; bidirectional flow for to-and-fro flow; and reversed flow for continuous hepatofugal flow. The bidirectional flow and the reversed flow were classified as NFPF in this study. The clinical findings and prognosis were compared between the patients with FPF and those with NFPF. The median follow-up period was 40.9 mo (range, 0.3-156.5 mo).


RESULTS
Twenty-four patients (10.8%) demonstrated NFPF, accompanied by lower albumin level, worse Child-Pugh scores, and model for end-stage liver disease scores. The portal hemodynamic features in the patients with NFPF were smaller diameter of the portal trunk; presence of short gastric vein, splenorenal shunt, or inferior mesenteric vein; and advanced collateral vessels (diameter > 8.7 mm, flow velocity > 10.2 cm/s, and flow volume > 310 mL/min). The cumulative incidence rates of NFPF were 6.5% at 1 year, 14.5% at 3 years, and 23.1% at 5 years. The collateral vessels characterized by flow velocity > 9.5 cm/s and those located at the splenic hilum were significant predictive factors for developing NFPF. The cumulative survival rate was significantly lower in the patients with NFPF (72.2% at 1 year, 38.5% at 3 years, 38.5% at 5 years) than in those with forward portal flow (84.0% at 1 year, 67.8% at 3 years, 54.3% at 5 years, P = 0.0123) using the Child-Pugh B and C classifications.


CONCLUSIONS
NFPF has a significant negative effect on the prognosis of patients with worse liver function reserve, suggesting the need for careful management.
Takayuki Kondo, Hitoshi Maruyama, Tadashi Sekimoto, Taro Shimada, Masanori Takahashi, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
Takayuki
T
Kondo
Takayuki Kondo, Hitoshi Maruyama, Tadashi Sekimoto, Taro Shimada, Masanori Takahashi, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
Hitoshi
H
Maruyama
Takayuki Kondo, Hitoshi Maruyama, Tadashi Sekimoto, Taro Shimada, Masanori Takahashi, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
Tadashi
T
Sekimoto
Takayuki Kondo, Hitoshi Maruyama, Tadashi Sekimoto, Taro Shimada, Masanori Takahashi, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
Taro
T
Shimada
Takayuki Kondo, Hitoshi Maruyama, Tadashi Sekimoto, Taro Shimada, Masanori Takahashi, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
Masanori
M
Takahashi
Takayuki Kondo, Hitoshi Maruyama, Tadashi Sekimoto, Taro Shimada, Masanori Takahashi, Osamu Yokosuka, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
Osamu
O
Yokosuka
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D003097:Collateral Circulation; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008642:Mesenteric Veins / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012307:Risk Factors; D013162:Splenic Vein / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color; D018617:Ultrasonography, Doppler, Pulsed; D055815:Young Adult
Cirrhosis; Doppler ultrasound; Non-forward portal flow; Portal hemodynamics; Reversed portal flow