{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:29:10Z","timestamp":1788827350671,"version":"build-2803163510"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","license":[{"start":{"date-parts":[[2020,7,16]],"date-time":"2020-07-16T00:00:00Z","timestamp":1594857600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:p>The etiology of portal hypertension (pHTN) in children differs from that of adults and may require different management strategies. We set out to review the etiology, management, and natural history of pHTN at a pediatric liver center. From 2008 to 2018, 151 children and adolescents with pHTN were identified at a free\u2010standing children\u2019s hospital. Patients were stratified by etiology of pHTN (intrahepatic disease [IH], defined as cholestatic disease and fibrotic or hepatocellular disease; extrahepatic disease [EH], defined as hepatic vein obstruction and prehepatic pHTN). Patients with EH were more likely to undergo an esophagoduodenscopy for a suspected gastrointestinal bleed (77% vs. 41%; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.01). Surgical interventions differed based on etiology (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.01), with IH more likely resulting in a transplant only (65%) and EH more likely to result in a shunt only (43%); 30% of patients with IH and 47% of patients with EH did not undergo an intervention for pHTN. Kaplan\u2010Meier analysis revealed a significant increase in mortality in the group that received no intervention compared to shunt, transplant, or both and lower mortality in patients with prehepatic pHTN compared to other etiologies (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.01 each). Multivariate analysis revealed increased odds of mortality in patients with refractory ascites (odds ratio [OR], 4.34; 95% confidence interval [CI], 1.00, 18.88; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.05) and growth failure (OR, 13.49; 95% CI, 3.07, 58.99; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.01). <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic> In this single institution study, patients with prehepatic pHTN had better survival and those who received no intervention had higher mortality than those who received an intervention. Early referral to specialized centers with experience managing these complex disease processes may allow for improved risk stratification and early intervention to improve outcomes.<\/jats:p>","DOI":"10.1002\/hep4.1560","type":"journal-article","created":{"date-parts":[[2020,7,16]],"date-time":"2020-07-16T08:18:27Z","timestamp":1594887507000},"page":"1346-1352","source":"Crossref","is-referenced-by-count":14,"title":["Natural Course of Pediatric Portal Hypertension"],"prefix":"10.1097","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6294-2800","authenticated-orcid":false,"given":"Al\u2010Faraaz","family":"Kassam","sequence":"first","affiliation":[{"name":"Division of Pediatric General and Thoracic Surgery,Cincinnati Children's Hospital Medical Center,Cincinnati,OH"},{"name":"Department of Surgery,University of Cincinnati,Cincinnati,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian R.","family":"Goddard","sequence":"additional","affiliation":[{"name":"Division of Pediatric General and Thoracic Surgery,Cincinnati Children's Hospital Medical Center,Cincinnati,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Johnston","sequence":"additional","affiliation":[{"name":"Division of Pediatric General and Thoracic Surgery,Cincinnati Children's Hospital Medical Center,Cincinnati,OH"},{"name":"Department of Surgery,University of Cincinnati,Cincinnati,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9686-8052","authenticated-orcid":false,"given":"Alexander R.","family":"Cortez","sequence":"additional","affiliation":[{"name":"Department of Surgery,University of Cincinnati,Cincinnati,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew T.","family":"Trout","sequence":"additional","affiliation":[{"name":"Department of Radiology,Cincinnati Children\u2019s Hospital Medical Center,Cincinnati,OH"},{"name":"Department of Radiology,University of Cincinnati College of Medicine,Cincinnati,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd M.","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Division of Pediatric General and Thoracic Surgery,Cincinnati Children's Hospital Medical Center,Cincinnati,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander G.","family":"Miethke","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition,Cincinnati Children's Hospital Medical Center,Cincinnati,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen M.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition,Cincinnati Children's Hospital Medical Center,Cincinnati,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9667-7742","authenticated-orcid":false,"given":"Jorge A.","family":"Bezerra","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition,Cincinnati Children's Hospital Medical Center,Cincinnati,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William F.","family":"Balistreri","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition,Cincinnati Children's Hospital Medical Center,Cincinnati,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaimie D.","family":"Nathan","sequence":"additional","affiliation":[{"name":"Division of Pediatric General and Thoracic Surgery,Cincinnati Children's Hospital Medical Center,Cincinnati,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria 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