HEPATIC AND PORTAL-VEIN THROMBOSIS IN CIRRHOSIS - POSSIBLE ROLE IN DEVELOPMENT OF PARENCHYMAL EXTINCTION AND PORTAL-HYPERTENSION

Obliterative lesions in portal veins (PVs) and hepatic veins (HVs) of all sizes are known to occur in cirrhotic livers. PV lesions have gene rally been attributed to thrombosis, but the pathogenesis of the HV (v eno-occlusive) lesions is unknown. We have studied 61 cirrhotic livers removed at transplantation to clarify the prevalence, distribution, a nd pathogenesis of venous lesions, as well as the association of these lesions with other morphological features and clinical morbidity. Int imal fibrosis that is highly suggestive of healed HV or PV thrombosis was found in at least 70% and 36C/o of livers, respectively. The distr ibution of HV lesions was patchy and largely confined to veins between 0.1 and 3 mm in diameter, suggesting multifocal origin in small veins . PV lesions were more uniform throughout the liver, suggesting origin in large veins with propagation to the small veins. HV lesions were a ssociated with regions of confluent fibrosis (focal parenchymal extinc tion), and PV lesions were associated with regional variation in the s ize of cirrhotic nodules and a history of bleeding varices. These obse rvations suggest that thrombosis of medium and large PVs and HVs is a frequent occurrence in cirrhosis, and that these events are important in causing progression of cirrhosis.