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Dissociation in hepatic vein pressure gradient, liver stiffness measurement and complications in histological subtypes of porto-sinusoidal vascular disease
  1. Chhagan Bihari,
  2. Sneha Dhariwal,
  3. Saggere Murlikrishna Shasthry,
  4. Archana Rastogi,
  5. Manoj Kumar Sharma,
  6. Shiv Kumar Sarin
  1. Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Chhagan Bihari, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India; drcbsharma{at}gmail.com

Abstract

Background and aims Portosinusoidal vascular disease (PSVD) is a broad term encompassing varied histological patterns with changes in portal tracts and sinusoids without cirrhosis. We aimed to assess whether there is any clinical and pathological difference among the various histological categories of PSVD.

Patients and methods This study included liver biopsy cases classified as PSVD (2020–2022). Clinical and laboratory parameters were obtained from the electronic records. PSVD cases were histologically categorised as obliterative portal venopathy (OPV), OPV with fibrosis (OPV-F), incomplete septal cirrhosis (ISC), nodular regenerative hyperplasia (NRH), mega sinusoids with fibrosis (MSF) and unclassified. Follow-up complications were recorded.

Results PSVD categories were OPV (45 (26%)), OPV-F (37 (21.4%)), ISC (20 (11.6%)), NRH (19 (11%)), MSF (19 (11%)) and unclassified (33 (19%)). Elevated hepatic venous pressure gradient (HVPG) was noted in OPV-F (10 (IQR: 12–14.7)) and ISC (12 (IQR: 9–14)) mm Hg with higher fibrosis quantity in liver tissue and elevated procollagen III aminoterminal propeptide, which correlated with HVPG. On immunohistochemistry, OPV-F and ISC showed lesser expression of ADAMT13 in liver biopsies (p<0.001). On follow-up, ascites development was more in OPV-F and ISC than in other categories (p=0.001). Higher liver stiffness measurement (LSM) values were recorded in MSF and NRH, compared with other categories, but it did not correlate with fibrosis in liver biopsy.

Conclusions OPV-F and ISC had higher HVPG, fibrosis, and more ascites development on follow-up than the other categories of PSVD, and all are not the same. In contrast, MSF and NRH have spuriously high LSM.

  • fibrosis
  • LIVER
  • Liver Diseases

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • CB and SD are joint first authors.

  • Handling editor Yoh Zen.

  • Contributors CB and SKS made the study concept and design; CB, SD, and AR acquired the data; CB, SD, SMS and MKS did the analysis and interpretation of data; CB, SD and SMS drafted the manuscript; MKS, SKS revised the manuscript for important intellectual content; SKS provided administrative, technical, or material support and study supervision. CB is the garantor of the manuscript

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.