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Updated: Jan 27, 2026
Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
Published on: June 18, 2020
Hepatic Venous Pressure Gradient Measurements in Children: Correlation With Hepatic Histology and Clinical Indicators
Noelle H Ebel1, Kristen Carlin2, Michele L Shaffer3
1Division of Gastroenterology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
Insights
Hepatic venous pressure gradients (HVPG) in children do not correlate with liver fibrosis or bleeding risk. Unlike adults, HVPG may not accurately predict complications of portal hypertension in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Clinical Measurement
Background:
- Elevated hepatic venous pressure gradients (HVPG) in adults correlate with liver fibrosis and predict adverse outcomes.
- Portal hypertension is a serious condition in children requiring accurate prognostic indicators.
Purpose of the Study:
- To investigate the association between HVPG measurements, histopathology, and clinical indicators of portal hypertension in children.
- To determine if HVPG can predict fibrosis severity and bleeding risk in pediatric patients.
Main Methods:
- Retrospective analysis of data from two pediatric centers (2006-2015).
- Included children with simultaneous HVPG measurement and transjugular liver biopsy.
- Reviewed medical charts for histopathology, imaging, endoscopic, and clinical data.
Main Results:
- HVPG measurements did not correlate with histological fibrosis (ρ=0.23, P=0.14) or portal inflammation (ρ=0.24, P=0.29).
- No significant difference in HVPG was found between children with and without a history of variceal bleeding (P=0.43).
- Elevated HVPG was observed in acute liver failure and chronic liver disease groups.
Conclusions:
- HVPG measurements in children do not correlate with the degree of hepatic fibrosis.
- HVPG is not associated with the presence of varices or a history of variceal bleeding in children.
- HVPG may not be a reliable predictor of portal hypertension complications in pediatric patients, unlike in adults.
Objectives:
In adults, elevated hepatic venous pressure gradients (HVPGs) are correlated with the degree of liver fibrosis on histopathology and predict worse outcomes including variceal bleeding and death. We aimed to examine the association between HVPG measurements, histopathologic findings, and clinical indicators of portal hypertension in children.
Methods:
Utilizing retrospective data from 2 pediatric centers between 2006 and 2015, we identified children who underwent simultaneous HVPG measurement and transjugular liver biopsy. Medical charts were reviewed for histopathology, imaging, endoscopic, and clinical data.
Results:
Forty-one children (median age 11 years) were included in the analysis with diagnoses of acute hepatitis (n = 15), chronic liver disease (n = 12), hepatic noncirrhotic portal hypertension (n = 4), acute liver failure (n = 3), and nonhepatic causes of portal hypertension (n = 7). Elevated mean HVPG measurements were found in children with acute liver failure (10 mmHg, range 4-12) and chronic liver disease (7 mmHg, range 1-12). HVPG measurements did not correlate with the histological severity of fibrosis (ρ = 0.23, P = 0.14) or portal inflammation (ρ = 0.24, P = 0.29), and no difference was found in HVPG when comparing children with and without a history of variceal bleeding (P = 0.43).
Conclusions:
HVPG measurements do not correlate significantly with the degree of hepatic fibrosis on biopsy. Furthermore, HVPG measurements are not associated with the presence of varices or history of variceal bleeding, suggesting the possibility of intrahepatic shunting in children with advanced liver disease. Therefore, unlike in adults, HVPG measurements may not accurately predict children who are at risk of complications from portal hypertension.
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