Published online May 27, 2018. doi: 10.4254/wjh.v10.i5.417
Peer-review started: February 3, 2018
First decision: March 8, 2018
Revised: April 23, 2018
Accepted: May 11, 2018
Article in press: May 11, 2018
Published online: May 27, 2018
A proportion of patients demonstrate (SD) in the absence of post-sinusoidal venous outflow impairment or portal vein thrombosis and the clinical significance of this finding is unclear. Long-term outcomes of patients with SD are not known. Moreover, there is no clear guidance on how such patients are to be investigated.
To better understand the clinical relevance and long-term outcomes of patients with non-obstructive SD.
To better characterize isolated non-obstructive SD by identifying associated conditions, laboratory findings, and histological patterns.
Retrospective chart review of patients with isolated non-obstructive SD.
Inflammatory conditions (32%) were the most common cause identified. The most common pattern of liver abnormalities was cholestatic (76%). The majority (78%) had localized SD localized to Zone III. Medication-related SD had higher proportion of portal hypertension (53%), ascites (58%), and median AST (113 U/L) and ALT (90 U/L) levels. Nineteen patients in our study died within one-year after diagnosis of SD. Ten patients died from complications related to underlying diseases associated with SD.
Significant proportion of SD may exist without impaired hepatic venous outflow. There does not appear to be any relationship between histological patterns and medical conditions. High one-year mortality rate in our cohort may suggest relationship between clinical status and development of SD. Isolated SD on liver biopsy, in the absence of congestive hepatopathy, requires further evaluation and portal hypertension should be rule out.
Future studies should evaluate the utility of screening for inflammatory/autoimmune condition or malignancy in patients with non-obstructive SD without an obvious cause.