Fibrosis evaluation by transient elastography in patients with long-term sustained HCV clearance

Virologic Cure of Hepatitis C: Impact on Hepatic Fibrosis and Patient Outcomes

Treatment with direct-acting antiviral agents has revolutionized the approach to hepatitis C. We are now able to obtain high sustained virological response (SVR) rates, even in the historically difficult-to-treat patient populations. SVR translates into improved clinical outcomes, particularly overall and liver-related mortality, and benefits are more striking in patients with cirrhosis. A 2.5- to 5-fold risk reduction in the incidence of hepatocellular carcinoma and improvement in complications derived from portal hypertension have been reported as well. It is hypothesized that the benefits from SVR occur largely due to regression of fibrosis, which arises from the halt on the fibrogenic stimuli and activation of extracellular matrix reabsorption signals. Non-invasive markers of fibrosis are being utilized to assess regression, but it is still unclear how accurate they are in this clinical scenario. Interventions aiming to improve liver wellness and screening for cirrhosis-related complications should continue to be the norm after SVR.

Serial Liver Stiffness Measurements and Monitoring of Liver-Transplanted Patients in a Real-Life Clinical Practice

BACKGROUND

Liver transplanted patients need close surveillance for early signs of graft disease.

OBJECTIVES

Transient elastography can safely be repeated over time, offering serial liver stiffness measurement values. Serial stiffness measurements were compared to single baseline stiffness measurements in predicting the appearance of liver-related clinical events and guiding subsequent clinical decisions.

METHODS

One hundred and sixty liver transplanted patients were observed for three years in our real-life practice.

RESULTS

Liver stiffness measurements were stable in 75% of patients, decreased in 4% of patients, and increased in 21% of patients. The pattern of increased stiffness measurements was associated with both HCV-RNA positive status and the presence of an active biliary complication of liver transplantation and was more predictive of a clinically significant event resulting from any disease of the transplanted liver when compared to a stable pattern or to a single liver stiffness measurement. The procedures that were consequently performed were often diagnostic for unexpected situations, both in HCV-RNA positive and HCV-RNA negative patients.

CONCLUSIONS

The pattern of longitudinally increased liver stiffness measurements efficiently supported clinical decisions for individualized management strategies. Repeated transient elastography in real-life clinical practice appears to have a practical role in monitoring liver transplanted patients.

Hepatitis C: Is Regression of Advanced Fibrosis Possible After Treatment?

Liver cirrhosis represents a severe complication for hepatitis C patients. Patients with cirrhosis require immediate treatment; a sustained virological response has been demonstrated to reduce the probability of complications and to improve the prognosis. The optimal outcome of treatment is regression, which in many cases is difficult to achieve due to histological changes. Nevertheless, cirrhosis regression has been reported in >50% of patients treated with antiviral drugs who were assessed by biopsy both before and after treatment. Similar results were obtained when transient elastography was used to estimate fibrosis stage. However, more studies with longer follow-up periods are necessary to confirm whether the decrease in liver stiffness resulting from a sustained virological response to a direct-acting antiviral is correlated with improved clinical outcomes.

The close linkage between the elasticity modulus measured by real-time mapping shear wave elastography and the presence of hepatocellular carcinoma in patients with a sustained virological response to interferon for chronic hepatitis C

PURPOSE

Some patients develop hepatocellular carcinoma (HCC) after sustained virological response (SVR) to interferon therapy for chronic hepatitis C (CH-C). The aim of this study was to examine the linkage between liver elasticity and the presence/absence of HCC in patients after SVR.

METHODS

We enrolled 42 patients who underwent real-time mapping shear wave elastography (SWE) after SVR to interferon therapy for CH-C. Of the 42 patients, six had HCC and 36 did not. We retrospectively compared the elasticity modulus and other clinical parameters between patients with and without HCC.

RESULTS

Elasticity modulus measured by SWE, age, and serum albumin was significantly different between patients with and without HCC. Age, Fibrosis-4 index, serum gamma-globulin, total protein, and albumin levels were significantly correlated with the elasticity modulus. Areas under receiver operating characteristic curves of elasticity modulus, gamma-globulin, and age for the presence of HCC were 0.963, 0.888, and 0.778, respectively. In patients with an elasticity modulus ≥6.5 kPa, both sensitivity and specificity for the presence of HCC were 83.3 %.

CONCLUSION

The study demonstrated the close linkage between the elasticity modulus measured by SWE and the presence of HCC in patients after SVR.