Impact of splenomegaly on portal hemodynamics and therapeutic implications of splenectomy in liver cirrhosis with portal hypertension: New insights into portal hypertensive splenopathy

• Project/Area Number: 25893166
• Research Category: Grant-in-Aid for Research Activity Start-up
• Allocation Type: Single-year Grants
• Research Field: Digestive surgery
• Research Institution: Kyushu University
• Principal Investigator: HIROFUMI Kawanaka 九州大学, 医学(系)研究科(研究院), 准教授 (10363334)
• Project Period (FY): 2013-08-30 – 2015-03-31
• Project Status: Completed (Fiscal Year 2014)
• Budget Amount: ¥2,730,000 (Direct Cost: ¥2,100,000、Indirect Cost: ¥630,000); Fiscal Year 2014: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000); Fiscal Year 2013: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000)
• Keywords: 脾門脈外科 / 門脈圧亢進症 / 脾機能亢進症 / 腹腔鏡下脾摘術

Outline of Final Research Achievements

We have shown here that splenomegaly in liver cirrhosis may actively contribute to the pathogenesis of portal hypertension by increasing intrahepatic vascular resistance and splanchnic flow. Splenectomy likely reduces portal venous pressure by two mechanisms: decreasing splanchnic blood flow and reducing intrahepatic vascular resistance by normalizing hepatic concentrations of ET-1 and NOx, leading to improvements in portal hypertension. splenomegaly has various deleterious effects including portal hemodynamics, fibrosis, and HCV infection. Thus, splenic dysfunction in liver cirrhosis with portal hypertension should be called portal hypertensive splenopathy rather than hypersplenism. Laparoscopic splenectomy can control portal hypertensive splenopathy less invasively and more safely, providing a feasible multidisciplinary treatment for patients with liver cirrhosis and portal hypertension, in combination with other modalities such as endoscopic treatment and IFN therapy.

Research Products

• [Journal Article] Optimal changes in portal hemodynamics induced by splenectomy during living donor liver transplantation. (2015)
  • Author(s): Wang H, Ikegami T, Harada N, Yoshizumi T, Soejima Y, Uchiyama H, Yamashita YI, Itoh S, Harimoto N, Kawanaka H, Shirabe K, Maehara Y.
  • Journal Title: Surgery today Volume: 45
  • Peer Reviewed
• [Journal Article] Effect of laparoscopic splenectomy on portal hemodynamics in patients with liver cirrhosis and portal hypertension. (2014)
  • Author(s): Kawanaka H, Akahoshi T, Kinjo N, Iguchi T, Ninomiya M, Yamashita Y, Ikegami T, Yoshizumi T, Shirabe K, Maehara Y.
  • Journal Title: Br J Surg Volume: 101 Issue: 12 Pages: 1585-1593
  • DOI: 10.1002/bjs.9622
  • Peer Reviewed / Acknowledgement Compliant
• [Journal Article] Optimizing risk stratification in portal vein thrombosis after splenectomy and its primary prophylaxis with antithrombin III concentrates and danaparoid sodium in liver cirrhosis with portal hypertension. (2014)
  • Author(s): Kawanaka H, Akahoshi T, Ito S, Iguchi T, Harimoto N, Uchiyama H, Yoshizumi T, Shirabe K, Takenaka K, Maehara Y.
  • Journal Title: J Am Coll Surg Volume: 219 Issue: 5 Pages: 865-874
  • DOI: 10.1016/j.jamcollsurg.2014.07.939
  • Peer Reviewed / Acknowledgement Compliant
• [Journal Article] 肝硬変症における脾摘術後の門脈血行動態の変化からみた肝脾相関についての検討． (2014)
  • Author(s): 川中博文, 赤星朋比古, 金城直, 吉田大輔, 橋本直隆, 上原英雄, 松本佳大, 吉屋匠平, 別城悠樹, 伊藤心二, 二宮瑞樹, 山下洋市, 池上徹, 吉住朋晴, 富川盛雅, 調憲, 前原喜彦．
  • Journal Title: 日本門脈圧亢進症学会雑誌 Volume: 20 Pages: 24-31
  • NAID: 130006832709
  • Peer Reviewed
• [Journal Article] 肝硬変症における脾摘術後の門脈血行動態の変化からみた肝脾相関についての検討 (2014)
  • Author(s): 川中博文
  • Journal Title: 日本門脈圧亢進症学会雑誌 Volume: Vol.20, No.1 Pages: 24-31
  • NAID: 130006832709
  • Peer Reviewed
• [Presentation] C型肝硬変症における脾摘術後の肝発癌および予後についての検討 (2014)
  • Author(s): 川中博文、赤星朋比古、播本憲史、伊藤心二、武石一樹、松本佳大、中川原英和、木村光一、王 歓林、今井大祐、別城悠樹、吉田佳弘、富野高弘、栗原 健、山下洋市、池上 徹、吉住朋晴、調 憲、池田哲夫、前原喜彦
  • Organizer: 第25回日本消化器がん発生学会
  • Place of Presentation: 福岡
  • Year and Date: 2014-11-13 – 2014-11-14
• [Presentation] C型肝硬変症における脾摘の臨床的意義 (2014)
  • Author(s): 川中博文、赤星朋比古、前原喜彦
  • Organizer: 第１２回日本消化器外科学会大会（JDDW2014）
  • Place of Presentation: 神戸
  • Year and Date: 2014-10-24