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Patients With Advanced Cirrhosis Have Some Degree Of Hepatic Arterial Buffer Response Preserved

Even patients with advanced cirrhosis who have significant portal hypertension have some degree of hepatic arterial buffer response preserved, say investigators at the University of Munich, Munich, Germany and Albrecht-Ludwigs-University, Freiburg.

They describe HABR as an important compensatory mechanism designed to maintain liver perfusion by hepatic vasodilation on reduction of portal venous perfusion. However, this mechanism is believed to be impaired in patients with advanced cirrhosis.

Accordingly, the investigators tested the effects of a transjugular intrahepatic portosystemic shunt (TIPS) on HABR as reflected by alterations in the resistance index (R1) of the hepatic artery.

Participants included 366 patients with cirrhosis who underwent duplex Doppler ultrasonographic examination, designed to determine the Resistance Index, and maximal flow velocity in the portal vein prior to and following TIPS placement. In addition, the portosystemic pressure gradient was determined both before and after TIPS placement.

Compared with 337 patients with hepatopetal flow, 29 patients with hepatofugal portal blood flow had a notably lower resistance index (0.63 ± 0.02 versus 0.69 ± 0.01; P < .001). A significant decrease of the RI was induced by TIPS in patients with hepatopetal flow (RI, 0.69 ± 0.01 before versus 0.64 ± 0.01 after TIPS; P=. 001) but not in patients with hepatofugal flow (RI, 0.63 ± 0.02 before vs .0.643 ± 0.02 after TIPS; NS).

This response was not dependent on the Child-Pugh class, the investigators say.
Hepatology 2002 Vol 35 No 3 pp 630-634. "Hepatic arterial buffer response in patients with advanced cirrhosis"

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