Portal pressure and liver stiffness measurements in the prediction of fibrosis regression after SVR in recurrent hepatitis C

Abstract

Sustained virological response (SVR) improves survival in post liver transplant (LT) recurrent hepatitis C. However, the impact of SVR on fibrosis regression is not well defined. In addition, the performance of noninvasive methods to evaluate the presence of fibrosis and portal hypertension after SVR has been scarcely evaluated. We aimed to investigate the degree of fibrosis regression (decrease ≥1 METAVIR stage) after SVR and its associated factors in recurrent hepatitis C, as well as the diagnostic capacity of noninvasive methods in the assessment of liver fibrosis and portal hypertension after viral clearance. We evaluated 112 HCV-infected LT recipients who achieved SVR between 2001 and 2015. A liver biopsy was performed before treatment and 12 months after SVR. HVPG, liver stiffness measurement (LSM) and ELF score were also determined at the same time points. Sixty-seven percent of the cohort presented fibrosis regression: 43% in recipients with cirrhosis and 72-85% in the remaining stages (p=0.002). HVPG, LSM and ELF significantly decreased after SVR. Liver function significantly improved, and survival was significantly better in patients achieving fibrosis regression. The baseline HVPG and LSM as well as decompensations before therapy were independent predictors of fibrosis regression. One year after SVR, LSM had a high diagnostic accuracy to discard the presence of advanced fibrosis and clinically significant portal hypertension (AUROCs 0.902 and 0.888). In conclusion, SVR after LT induces fibrosis regression in most patients, leading to significant clinical benefits. Pre-treatment HVPG and LSM are significant determinants of the likelihood of fibrosis regression. Finally, LSM accurately predicts the presence of advanced fibrosis and portal hypertension one year after SVR, and thus, can be used to determine monitoring strategies. This article is protected by copyright. All rights reserved.

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