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Spleen stiffness can non‐invasively assess resolution of portal hypertension after liver transplantation
Author(s) -
Chin Jun Liong,
Chan Grace,
Ryan John D.,
McCormick P. Aiden
Publication year - 2015
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12647
Subject(s) - medicine , transient elastography , portal hypertension , spleen , cirrhosis , portal venous pressure , interquartile range , gastroenterology , transplantation , liver transplantation , arterial stiffness , varices , esophageal varices , cardiology , surgery , urology , blood pressure , liver fibrosis
Abstract Background & Aims Spleen stiffness can be measured by transient elastography. Recent studies have shown that spleen stiffness correlates with hepatic venous pressure gradient and can predict oesophageal varices. Elevated spleen stiffness in cirrhosis has been attributed to splenic tissue hyperplasia and fibrosis, portal hypertension and its consequent hyperdynamic circulation. The aim of this study was to investigate changes to spleen stiffness after orthotopic liver transplantation ( OLT ) when portal hypertension resolves. Methods Twenty‐one patients awaiting OLT were studied prospectively, while 11 post‐transplant patients were recruited as controls. Spleen and liver stiffness were measured with Fibroscan before and at 2–8 weeks after OLT . Criteria applied for spleen stiffness measurement were similar to liver stiffness (≥10 measurements; ≥60% success rate; interquartile range, IQR <30% of median). Results Spleen stiffness was significantly higher before OLT compared to post‐transplant patients [75.0 (63.9–75.0) kP a vs. 28.4 (22.0–37.5) kP a; P < 0.0001]. For patients awaiting OLT, 90% (19/21) had oesophageal varices (endoscopically or radiologically). In patients who underwent liver transplantation, spleen stiffness decreased significantly from a median of 75.0 (62.0–75.0) kP a before OLT, to 41.9 (27.0–47.4) kP a at 2 weeks after transplant and 32.9 (29.1–38.0) kP a in the subsequent 4–8 weeks after OLT ( P < 0.0001). As expected, liver stiffness measurements reduced from 39.3 (24.9–75.0) kP a to 8.6 (6.8–11.8) kP a in patients receiving OLT ( P = 0.0004). Conclusions Spleen stiffness can non‐invasively assess changes in portal pressure after liver transplantation and decreases significantly when portal hypertension resolves.