Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2015; 21(29): 8894-8902
Published online Aug 7, 2015. doi: 10.3748/wjg.v21.i29.8894
Reversed portal flow: Clinical influence on the long-term outcomes in cirrhosis
Takayuki Kondo, Hitoshi Maruyama, Tadashi Sekimoto, Taro Shimada, Masanori Takahashi, Osamu Yokosuka
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
Author contributions: Maruyama H was responsible for the study concept and design; Kondo T, Maruyama H, Sekimoto T, Shimada T and Takahashi M collected the data; Kondo T and Maruyama H analyzed the data; Kondo T drafted the manuscript; and Maruyama H and Yokosuka O provided critical revisions of the manuscript for important intellectual content.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki, and was approved by the Ethics Committee of Chiba University Graduate School of Medicine.
Informed consent statement: Informed written consent for research use of medical records was obtained from all of the patients.
Conflict-of-interest statement: All of the authors declare that there are no potential conflicts of interest and that they have received no funding for this paper.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hitoshi Maruyama, MD, PhD, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba 260-8670, Japan. maru-cib@umin.ac.jp
Telephone: +81-43-2262083 Fax: +81-43-2262088
Received: January 16, 2015
Peer-review started: January 17, 2015
First decision: April 13, 2015
Revised: April 27, 2015
Accepted: June 26, 2015
Article in press: June 26, 2015
Published online: August 7, 2015
Processing time: 203 Days and 21 Hours
Abstract

AIM: 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.

CONCLUSION: NFPF has a significant negative effect on the prognosis of patients with worse liver function reserve, suggesting the need for careful management.

Keywords: Non-forward portal flow; Reversed portal flow; Cirrhosis; Doppler ultrasound; Portal hemodynamics

Core tip: The influence of non-forward portal flow (NFPF) in cirrhosis has not been determined. The present study examined the effect of NFPF on the natural history of cirrhosis in 222 patients (median follow-up period 40.9 mo). The cumulative incidences of NFPF was as follows: 6.5% at 1 year, 14.5% at 3 years, and 23.1% at 5 years. The cumulative survival rate was significantly lower in patients with NFPF (72.2% at 1 year, 38.5% at 3 years, and 38.5% at 5 years) than in those with forward portal flow (84.0% at 1 year, 67.8% at 3 years, and 54.3% at 5 years, P = 0.0123) using Child-Pugh B and C classifications, suggesting the need for careful management of these patients.