Japanese Journal of Portal Hypertension

The effect of terlipressin on systemic, hepatic, and renal hemodynamics was studied by means of catheterization of hepatic vein and pulmonary artery, and duplex Doppler ultrasonography of portal and splenic vein performed before and after intravenous administration of 1 mg terlipressin in 10 patients with liver cirrhosis. Following terlipressin administration, mean arterial pressure and systemic vascular resistance increased significantly, and heart rate and cardiac output decreased significantly. Hepatic venous pressure gradient and portal venous blood flow decreased significantly by 19.4% (18.6 mm Hg to 15.0 mm Hg) and 32.5% (714 ml/min to 482 ml/min), respectively. Renal arterial resistive index decreased significantly (0.74 to 0.69). There were no severe adverse events. These results suggest that terlipressin decreases portal pressure through the reduction of portal blood flow, attenuates the hyperdynamic circulation, and decreases renal arterial resistance in liver cirrhosis. It is expected that terlipressin have beneficial effects on hemodynamics in cirrhotic patients with hepatorenal syndrome.

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We have preferably performed splenectomy for patients with liver cirrhosis (LC) and huge splenomegaly mainly aiming at an increase in platelet counts that enables interferon (IFN) treatment or treatment of hepato cellular carcinoma. In the course of the splenectomy we were aware that that splenectomy has additional clinical benefit.
In the present study we have assessed the effect of splenectomy on portal hypertension, hepatic encephalopathy and several liver functions in 60 patients with LC who underwent splenectomy. Portal pressure significantly decreased from 22 to 17 mmHg after hepatectomy. Esophago-gastric varix improved in 74 % after splenectomy, and 100 % after Hassab's operation respectively. Platelet counts, serum albumin level, and prothrombin time level were significantly increased, and serum total bilirubin and ammonia levels were significantly decreased 1 year after the surgery. Hepaic encephalopathy disappeared in 4 cases, and IFN therapy was able to initiate in 2 cases.
Although thrombosis occurred in 10 case (17 %), it didn't show any significant liver function derangements, and was successfully treated with anti-coagulant therapy. There were no other fatal complications.
Splenectomy is worth attempting in patients with LC and huge splenomegaly because it improves portal hypertension, and several liver functions including platelet counts, and enables IFN treatment or treatment for hepatocellular carcinoma.

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