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Hepatic Venous Pressure Gradient Measurements in Children

Correlation With Hepatic Histology and Clinical Indicators of Portal Hypertension

Ebel, Noelle H.*; Carlin, Kristen; Shaffer, Michele L.; Shivaram, Giri§; Hawkins, Matthew||; Lane, Erin R.; Cooper, Kara; Lindquester, Will S.#; Gadodia, Gaurav**; Murray, Karen F.†,¶

Journal of Pediatric Gastroenterology and Nutrition: June 2019 - Volume 68 - Issue 6 - p 788–792
doi: 10.1097/MPG.0000000000002327
Original Articles: Hepatology

Objectives: In adults, elevated hepatic venous pressure gradients (HVPGs) are correlated with the degree of liver fibrosis on histopathology and predict worse outcomes including variceal bleeding and death. We aimed to examine the association between HVPG measurements, histopathologic findings, and clinical indicators of portal hypertension in children.

Methods: Utilizing retrospective data from 2 pediatric centers between 2006 and 2015, we identified children who underwent simultaneous HVPG measurement and transjugular liver biopsy. Medical charts were reviewed for histopathology, imaging, endoscopic, and clinical data.

Results: Forty-one children (median age 11 years) were included in the analysis with diagnoses of acute hepatitis (n = 15), chronic liver disease (n = 12), hepatic noncirrhotic portal hypertension (n = 4), acute liver failure (n = 3), and nonhepatic causes of portal hypertension (n = 7). Elevated mean HVPG measurements were found in children with acute liver failure (10 mmHg, range 4–12) and chronic liver disease (7 mmHg, range 1–12). HVPG measurements did not correlate with the histological severity of fibrosis (ρ = 0.23, P = 0.14) or portal inflammation (ρ = 0.24, P = 0.29), and no difference was found in HVPG when comparing children with and without a history of variceal bleeding (P = 0.43).

Conclusions: HVPG measurements do not correlate significantly with the degree of hepatic fibrosis on biopsy. Furthermore, HVPG measurements are not associated with the presence of varices or history of variceal bleeding, suggesting the possibility of intrahepatic shunting in children with advanced liver disease. Therefore, unlike in adults, HVPG measurements may not accurately predict children who are at risk of complications from portal hypertension.

*Division of Gastroenterology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA

Center for Clinical and Translational Research, Seattle Children's Research Institute

Department of Statistics, University of Washington

§Department of Radiology, University of Washington School of Medicine, Seattle, WA

||Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA

Division of Gastroenterology and Hepatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA

#Emory University School of Medicine

**Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.

Address correspondence and reprint requests to Noelle H. Ebel, MD, Division of Gastroenterology, Department of Pediatrics, Stanford University School of Medicine, 750 Welch Road, Suite 116, Palo Alto, CA 94304 (e-mail:

Received 31 July, 2018

Accepted 15 January, 2019

This work was supported in part by an NIDDK training grant to the Division of Gastroenterology at the University of Washington (T32 DK007742).

The authors report no conflicts of interest.

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© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,