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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Isolated hepatic non-obstructive sinusoidal dilatation, 20-year single center experience
Dharma Budi Sunjaya, Guilherme Piovezani Ramos, Manuel Bonfim Braga Neto, Ryan Lennon, Taofic Mounajjed, Vijay Shah, Patrick Sequeira Kamath, Douglas Alano Simonetto
Dharma Budi Sunjaya, Guilherme Piovezani Ramos, Manuel Bonfim Braga Neto, School of Graduate Medical Education, Mayo Clinic, Rochester, MN 55905, United States
Ryan Lennon, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, United States
Taofic Mounajjed, Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States
Vijay Shah, Patrick Sequeira Kamath, Douglas Alano Simonetto, Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Sunjaya DB contributed to study design, data collection, analysis, drafting, and critical review of the manuscript; Ramos GP contributed to study design, data collection; Braga Neto MB contributed to study design, data collection; Mounajjed T contributed to analysis and critical review of manuscript; Shah V contributed to analysis and critical review of manuscript; Kamath PS contributed to the study design, analysis, and critical review of manuscript; Simonetto DA contributed to study design, data-collection, analysis, drafting of manuscript, and critical review of manuscript.
Institutional review board statement: The study was reviewed and approved by the Mayo Clinic Institutional Review Board.
Informed consent statement: Minimal risk study, waiver of informed consent applied.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This is an open-access article that 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: Douglas Alano Simonetto, MD, Assistant Professor, Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States.
simonetto.douglas@mayo.edu
Telephone: +1-480-3018000
Received: January 29, 2018
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
Processing time: 114 Days and 4 Hours
ARTICLE HIGHLIGHTS
Research Background
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.
Research motivation
To better understand the clinical relevance and long-term outcomes of patients with non-obstructive SD.
Research objectives
To better characterize isolated non-obstructive SD by identifying associated conditions, laboratory findings, and histological patterns.
Research methods
Retrospective chart review of patients with isolated non-obstructive SD.
Research results
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.
Research conclusions
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.
Research perspectives
Future studies should evaluate the utility of screening for inflammatory/autoimmune condition or malignancy in patients with non-obstructive SD without an obvious cause.
