Viral Hepatitis
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2005; 11(25): 3882-3886
Published online Jul 7, 2005. doi: 10.3748/wjg.v11.i25.3882
Natural history of major complications in hepatitis C virus-related cirrhosis evaluated by per-rectal portal scintigraphy
Etsushi Kawamura, Daiki Habu, Takehiro Hayashi, Ai Oe, Jin Kotani, Hirotaka Ishizu, Kenji Torii, Joji Kawabe, Wakaba Fukushima, Takashi Tanaka, Shuhei Nishiguchi, Susumu Shiomi
Etsushi Kawamura, Takehiro Hayashi, Ai Oe, Jin Kotani, Hirotaka Ishizu, Kenji Torii, Joji Kawabe, Susumu Shiomi, Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abenoku, Osaka 545-8585, Japan
Daiki Habu, Shuhei Nishiguchi, Department of Hepatology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abenoku, Osaka 545-8585, Japan
Wakaba Fukushima, Takashi Tanaka, Department of Public Health, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abenoku, Osaka 545-8585, Japan
Author contributions: All authors contributed equally to the work.
Supported by the Study Group of Portal Malcirculation supported by Ministry of Health, Labour and Welfare
Correspondence to: Dr. Etsushi Kawamura, 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
Telephone: +81-6-66453885 Fax: +81-6-66460686
Received: December 7, 2004
Revised: December 15, 2004
Accepted: December 20, 2004
Published online: July 7, 2005
Abstract

AIM: 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 ≤ 10%; group II, 10%<PSI<30%; and group III, 30% ≤ 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.

CONCLUSION: 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.

Keywords: Portal shunt index, Porto-systemic shunting, Per-rectal portal scintigraphy, Natural history, Liver cirrhosis, HCV, Hepatocellular carcinoma, Liver failure, Varix