3. 2014 Robbins
….although uncommon regression of fibrosis does occur ..
..we now understand that regression of scars can take place ..
All cirrhotic livers show elements of progression and regression, the balance
determined by the severity and persistence of the underlying disease.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14. Histological-hemodynamic
correlation in cirrhosis
• S. Nagula, D. Jain, R.J. Groszmann, G. Garcia-Tsao. Histological-
hemodynamic correlation in cirrhosis-a histological classification of the
severity of cirrhosis. J Hepatol, 44 (2006), pp. 111–117
• M. Kumar, P. Sakhuja, A. Kumar, N. Manglik, A. Choudhury, S. Hissar,
S K Sarin. Histological subclassification of cirrhosis based on
histological-haemodynamic correlation. Aliment Pharmacol Ther, 27
(2008), pp. 771–779
• S. Sethasine, D. Jain, R.J. Groszmann, G. Garcia-Tsa. Quantitative
histological-hemodynamic correlations in cirrhosis. Hepatology, 55
(2012), pp. 1146–1153
15. • AASLD/NIH position paper
• Hepatology. 2010 Apr; 51(4): 1445–1449.
• Now There Are Many (Stages) Where Before
There Was One: In Search of a Pathophysiological
Classification of Cirrhosis
• Guadalupe Garcia-Tsao (Yale University), Scott
Friedman (Mount Sinai, New York), John Iredale
(university of Edinburgh), and Massimo Pinzani
(University of Firenze, Italy).
16.
17. • We encourage the practicing community,
pathologists, and investigators to move beyond
the simple characterization of cirrhosis as a single
stage and instead begin thinking of cirrhosis as a
series of critical steps that, if left unchecked,
culminate in hepatic decompensation.
• A new framework for classifying cirrhosis will
require integration of both current and emerging
knowledge about liver structure and function
• From one stage, there should emerge many.
18. assessment of cirrhosis stage
- clinical severity
• HVPG correlates well with increasing severity of liver
disease. Fibrosis stages 3 or 4 have an HVPG of ≥ 6
mmHg; HVPG > 10 mmHg defines the presence of
“clinically significant portal hypertension”
• Simple histologic features - thickness of fibrous septa
correlates with HVPG; predictor of clinically significant
portal hypertension
• Liver stiffness measurement (LSM) obtained by transient
elastography - excellent correlation with HVPG values up to
10–12 mmHg
need to be further substantiated
19.
20.
21.
22.
23.
24.
25.
26.
27. Long term changes in liver histology following treatment of chronic hepatitis C
virus
Mitchell L. Shiffman,* Richard K. Sterling,** Melissa Contos,*** Sarah Hubbard,** April Long,*
Velimir A. Luketic,** R. Todd Stravitz,** Michael Fuchs,** Arun J. Sanyal**
Annals of Hepatology 2013
28. Regression of fibrosis
• All these studies show reversal of fibrosis in cirrhosis
• BUT
- Reversal in early cirrhosis (diagnosed on histology)
but not in clinical cirrhosis
- definitely not in decompensated cirrhosis
- No reversal of vascular changes
• Reversal of histological cirrhosis but not clinical
cirrhosis
• “Point of no return” in cirrhosis
