The Role of the Spleen in Portal Hypertension.

As liver disease progresses, intrahepatic vascular resistance increases (backward flow theory of portal hypertension) and collateral veins develop. Adequate portal hypertension is required to maintain portal flow into the liver through an increase in blood flow into the portal venous system (forward flow theory of portal hypertension). The splenic artery resistance index is significantly and selectively elevated in cirrhotic patients. In portal hypertension, a local hyperdynamic state occurs around the spleen. Splenomegaly is associated with a poor prognosis in cirrhosis and is caused by spleen congestion and by enlargement and hyperactivation of splenic lymphoid tissue. Hypersplenism can lead to thrombocytopenia caused by increased sequestering and breakdown of platelets in the spleen. The close relationship between the spleen and liver is reflected in the concept of the hepatosplenic axis. The spleen is a regulatory organ that maintains portal flow into the liver and is the key organ in the forward flow theory of portal hypertension. This review summarizes the literature on the role of the spleen in portal hypertension.

[1]  P. Galle,et al.  Baseline Splenic Volume Outweighs Immuno-Modulated Size Changes with Regard to Survival Outcome in Patients with Hepatocellular Carcinoma under Immunotherapy , 2022, Cancers.

[2]  P. Vishnyakova,et al.  Spleen: Reparative Regeneration and Influence on Liver , 2022, Life.

[3]  C. Menias,et al.  Abdominal and pelvic splenosis: atypical findings, pitfalls, and mimics , 2022, Abdominal Radiology.

[4]  J. Akatsuka,et al.  Risk factor analysis of intravesical recurrence after retroperitoneoscopic nephroureterectomy for upper tract urothelial carcinoma , 2021, BMC Urology.

[5]  H. Yoshida,et al.  Management of portal hypertension based on portal hemodynamics , 2021, Hepatology research : the official journal of the Japan Society of Hepatology.

[6]  S. Lewis,et al.  Structure and function of the immune system in the spleen , 2019, Science Immunology.

[7]  J. García‐Pagán,et al.  Idiopathic Portal Hypertension , 2018, Hepatology.

[8]  M. McConnell,et al.  Biology of portal hypertension , 2017, Hepatology International.

[9]  Zong-fang Li,et al.  The spleen in liver cirrhosis: revisiting an old enemy with novel targets , 2017, Journal of Translational Medicine.

[10]  A. Sauvanet,et al.  Medical complications following splenectomy. , 2016, Journal of visceral surgery.

[11]  O. Yokosuka,et al.  Reversed portal flow: Clinical influence on the long-term outcomes in cirrhosis. , 2015, World journal of gastroenterology.

[12]  R. Groszmann,et al.  Evolution in the understanding of the pathophysiological basis of portal hypertension: How changes in paradigm are leading to successful new treatments. , 2015, Journal of hepatology.

[13]  Prabhu Dayal Sinwar,et al.  Overwhelming post splenectomy infection syndrome - review study. , 2014, International journal of surgery.

[14]  T. Utsunomiya,et al.  Cytokine expression in spleen affects progression of liver cirrhosis through liver–spleen cross‐talk , 2014, Hepatology research : the official journal of the Japan Society of Hepatology.

[15]  G. Casazza,et al.  Spleen stiffness measurement can predict clinical complications in compensated HCV-related cirrhosis: a prospective study. , 2014, Journal of hepatology.

[16]  R. Hoover,et al.  Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up , 2014, Haematologica.

[17]  G. Tarantino,et al.  Liver-spleen axis: intersection between immunity, infections and metabolism. , 2013, World journal of gastroenterology.

[18]  Tomomi Yamada,et al.  Dual cytoprotective effects of splenectomy for small‐for‐size liver transplantation in rats , 2012, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[19]  Wei Wei,et al.  Enhanced liver regeneration in IL-10-deficient mice after partial hepatectomy via stimulating inflammatory response and activating hepatocyte STAT3. , 2011, The American journal of pathology.

[20]  C. Hellerbrand,et al.  Amelioration of portal hypertension and the hyperdynamic circulatory syndrome in cirrhotic rats by neuropeptide Y via pronounced splanchnic vasoaction , 2011, Gut.

[21]  M. Mejías,et al.  Relevance of the mTOR signaling pathway in the pathophysiology of splenomegaly in rats with chronic portal hypertension. , 2010, Journal of hepatology.

[22]  M. Hashizume,et al.  GENERAL RULES FOR RECORDING ENDOSCOPIC FINDINGS OF ESOPHAGOGASTRIC VARICES (2ND EDITION) , 2010, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[23]  E. Uchida,et al.  Successful management of a symptomatic splenic artery aneurysm with transcatheter embolization. , 2009, Journal of Nippon Medical School = Nippon Ika Daigaku zasshi.

[24]  M. Manns,et al.  Thrombocytopenia associated with chronic liver disease. , 2008, Journal of hepatology.

[25]  A. Gatta,et al.  Vasoactive factors and hemodynamic mechanisms in the pathophysiology of portal hypertension in cirrhosis. , 2008, Molecular aspects of medicine.

[26]  M. Mejías,et al.  Reversal of portal hypertension and hyperdynamic splanchnic circulation by combined vascular endothelial growth factor and platelet‐derived growth factor blockade in rats , 2007, Hepatology.

[27]  S. Choi,et al.  Adverse effect of splenectomy on recurrence in total gastrectomy cancer patients with perioperative transfusion. , 2006, American journal of surgery.

[28]  R. Groszmann,et al.  The hyperdynamic circulation of chronic liver diseases: From the patient to the molecule , 2006, Hepatology.

[29]  Y. Mizuguchi,et al.  Long-Term Results of Partial Splenic Artery Embolization as Supplemental Treatment for Portal-Systemic Encephalopathy , 2005, The American Journal of Gastroenterology.

[30]  Y. Mizuguchi,et al.  Splenic artery embolization before laparoscopic splenectomy in children , 2005, Surgical Endoscopy And Other Interventional Techniques.

[31]  Y. Mizuguchi,et al.  Hand-assisted laparoscopic hepatectomy after partial splenic embolization , 2003, Surgical Endoscopy And Other Interventional Techniques.

[32]  L. Bolondi,et al.  Influence of the Spleen on Portal Haemodynamics: a Non-invasive Study with Doppler Ultrasound in Chronic Liver Disease and Haematological Disorders , 2002, Scandinavian journal of gastroenterology.

[33]  K. Sharkey,et al.  Hyperdynamic circulation in portal‐hypertensive rats is dependent on central c‐fos gene expression , 2002, Hepatology.

[34]  M. Hashizume,et al.  Role of the spleen in liver fibrosis in rats may be mediated by transforming growth factor β‐1 , 2002, Journal of gastroenterology and hepatology.

[35]  M. Valgimigli,et al.  Systemic and splanchnic hemodynamic changes after liver transplantation for cirrhosis: A long‐term prospective study , 1999, Hepatology.

[36]  Fabio Piscaglia,et al.  Superior mesenteric artery impedance in chronic liver diseases: relationship with disease severity and portal circulation , 1998, American Journal of Gastroenterology.

[37]  R. Stauber,et al.  Vasopressin reverses mesenteric hyperemia and vasoconstrictor hyporesponsiveness in anesthetized portal hypertensive rats , 1998, Hepatology.

[38]  P. Angeli,et al.  Splenic impedance indices: A useful method to monitor patients after liver transplantation? , 1998, Hepatology.

[39]  T. Gupta,et al.  Pathophysiology of portal hypertension. , 1997, Clinics in liver disease.

[40]  T. Tajiri,et al.  Hepatic lobar differences in progression of chronic liver disease: Correlation of asialoglycoprotein scintigraphy and hepatic functional reserve , 1997, Hepatology.

[41]  M. Halliwell,et al.  Splanchnic blood flow in patients with cirrhosis and portal hypertension: investigation with duplex Doppler US. , 1995, Radiology.

[42]  J. Utsunomiya,et al.  The effect of splenomegaly on splanchnic hemodynamics in nonalcoholic cirrhosis after distal splenorenal shunt and splenopancreatic disconnection , 1994, Hepatology.

[43]  F. Moriyasu,et al.  Distribution of mesenteric and splenic blood flow in cirrhosis of the liver as estimated by radionuclide angiography. , 1993, Internal medicine.

[44]  R. Gibson,et al.  Duplex Doppler ultrasound signs of portal hypertension: relative diagnostic value of examination of paraumbilical vein, portal vein and spleen. , 1992, Australasian radiology.

[45]  R. Gibson,et al.  Splenomegaly--an insensitive sign of portal hypertension. , 1990, Australian and New Zealand journal of medicine.

[46]  S. Todo,et al.  Reversal of hypersplenism following orthotopic liver transplantation. , 1989, Annals of surgery.

[47]  A. Ferrante,et al.  Alterations in function and subpopulations of peripheral blood mononuclear leukocytes in children with portal hypertension. Leukocyte subtypes and function in portal hypertension. , 1989, International archives of allergy and applied immunology.

[48]  D. Granger,et al.  "Forward" and "backward" flow mechanisms of portal hypertension. Relative contributions in the rat model of portal vein stenosis. , 1985, Gastroenterology.

[49]  R. Williams,et al.  Injection studies of the splenic vasculature in portal hypertension. , 1966, Gut.