Portal flow augmentation for liver cirrhosis

Background: Portal hypertension due to chronic liver disease is a major cau se of death worldwide. Orthotopic liver transplantation offers the best the rapeutic option but is available to only a minority of patients. In the pas t few years mechanically pumping portal venous inflow has been reported to reduce portal hypertension and improve liver function. Methods: A review of the published data on augmented portal perfusion for t he treatment of portal hypertension in cirrhosis was carried out by searchi ng Medline and other online databases. From each published study portal pre ssure and blood flow data before and after augmented portal perfusion were used to calculate the change in mean intrahepatic portal vascular resistanc e (IHPR). The standardized data were then combined to allow meta-analysis. Results: Seven papers were identified on normal and cirrhotic animal and hu man livers with augmented dow (50% to fourfold over baseline) for 30-180 mi n. Meta-analysis revealed that the increased portal venous inflow was assoc iated with a significant rise in portal venous pressure on the hepatic side (P < 0.001), a significant reduction on the mesenteric side (P < 0.001) an d a significant reduction in IHPR (P = 0.013). Limited data were available to support improved liver function, Conclusion: Detailed in vivo cirrhotic liver studies on augmented portal fl ow in experimental models assessing haemodynamic and functional changes are required before clinical evaluation.