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Dear friends,
Just one clarification: VALDIG general assembly meeting will take place in London at ILC, on June 23, from 11.30 AM to 1.30PM, London time.
Best wishes
Pierre-EmmanuelDear Diraj,
Yes. This is 5 PM CET. Here is the link.
Best regards
Pierre-EmmanuelVALDIG General assembly
Jeudi, 16 septembre⋅17:00 à 20:00
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Pierre Emmanuel Rautou vous invite à une réunion Zoom planifiée.Participer à la réunion Zoom
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ID de réunion : 829 5217 4417Dear Diraj,
Thanks for the follow-up.
UDCA as been shown as beneficial as a prophylaxis in BMT (Ruutu Biol Blood Marrow Transplant. 2014), although the hepatic endpoint was rather vague. But it does not harm. In Paris, UDCA is very widely given as a prophylaxis in BMT.
Best regards
Pierre-EmmanuelDear Dhiraj,
I completely share what has been said: scarce data but in this specific setting Defibrotide on top of UDCA seems reasonable.
Best wishes
Pierre-EmmanuelDear Steve and all,
Thank you for stimulating the debate.
One rational for the term “Portosinusoidal vascular disease (PSVD)” is precisely that PSVD natural history starts -like all liver diseases- with a form without portal hypertension. A term referring to portal hypertension (e.g. idiopathic portal hypertension) does not allow to take that aspect into account (and leads us to focusing on the tip of the iceberg).
Parsing these patients by associated or underlying conditions is likely a good idea, but for the moment we lack data allowing us to identify the precise groups of patients.
At ILC2021 -organised by EASL- in June, there will be a session on PSVD, with a debate on these points. I invite all VALDIG members to join this interactive session.
Best wishes
Pierre-EmmanuelDear Antonio, dear friends,
Happy new year to the VALDIG group.
I agree that revising TIPS, including pressure measurement in the portal trunk, would be very useful. This thrombosis of portal trunk is surprising and desserves investigations.
Anticoagulation will likely be useful to avoid extension of thrombosis, particularly if thrombosis of the portal trunk and of splenic vein are recent.
I would be very cautious with splenectomy given the bad results the VALDIG group reported in Hepatology: PMID: 30924941
I would really favor -as mentioned above- splenic vein recanalization since it would likely be -if feasible- a good option.
Best regards
Pierre-EmmanuelDear colleague,
Thank you for sharing with us this case.
1. Has a myeloproliferative neoplasm been firmly ruled out? With such a large spleen, it is important.
2. I would be reluctant to splenectomy or to any procedure like splenic artery embolization.
3. I agree with Dr Daniel R. Ganger than portal vein recalization should be considered.
4. Liver transplantation is indeed the option if portal vein recanalization is not feasible/fails and if there is a patent superior mesenteric vein.
Best regards
Pierre-Emmanuel RautouHôpital Beaujon, Clichy, France
Dear Audrey, dear colleagues,
We have here a patient with INCPH and a thrombus that occurred at a period well known to be procoagulant (postpartum). She has been treated with anticoagulation for 1 year. At the stage we are now, there is no data supporting one attitude (no anticoagulation) or the other (anticoagulation). In situations at risk (pregnancy, hospitalization, etc) anticoagulaion is likely needed.
If anticoagulation is discontinued, I would personally (extrapolating on data from Delgato CGH 2012 obtained in cirrhosis and our local experience on PVT) propose an ultrasonography at 1 and 3 months and a CT scan at 6 month. I thrombosis recurs, then anticoagulation is clearly needed on the long term.Best regards
Pierre-EmmanuelHere are the links:
The program: http://www.easl.eu/medias/PDFs/BArcelone%20school/BARCELONA-Programme.pdf
The applications: http://www.easl.eu/discover/events/detail/2018/liver-vascular-biology
