Sabela Lens1, Anna Baiges1, Edilmar Alvarado-Tapias2, Elba LLop3, Javier Martinez4, Jose Ignacio Fortea5, Luís Ibáñez-Samaniego6, Zoe Mariño1, Sergio Rodríguez-Tajes1, Adolfo Gallego2, Rafael Bañares6, Ángela Puente5, Agustín Albillos4, Jose Luis Calleja3, Xavier Torras2, Virginia Hernández-Gea1, Jaume Bosch7, Cándid Villanueva2, Juan Carlos García-Pagán8, Xavier Forns1. 1. Liver Unit, Hospital Clínic, Barcelona, Universidad de Barcelona, IDIBAPS, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD). 2. Gastroenterology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD). 3. Liver Unit, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD). 4. Servicio de Gastroenterologia y Hepatología, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD). 5. Digestive Diseases Department, Marqués de Valdecilla University Hospital, IDIVAL, Santander, Spain. 6. Liver Unit, Hospital Gregorio Marañón, Facultad de Medicina, Universidad Complutense Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD). 7. Liver Unit, Hospital Clínic, Barcelona, Universidad de Barcelona, IDIBAPS, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Hepatology, Inselspital, Bern University, Bern, Switzerland. 8. Liver Unit, Hospital Clínic, Barcelona, Universidad de Barcelona, IDIBAPS, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD). Electronic address: jcgarcia@clinic.cat.
Abstract
BACKGROUND & AIMS: Clinically significant portal hypertension (CSPH), defined as a hepatic venous pressure gradient (HVPG) ≥10 mmHg, persists 24 weeks after sustained virological response (SVR) in up to 78% of patients with HCV-related cirrhosis treated with direct-acting antivirals. These patients remain at risk of decompensation. However, long-term paired clinical and hemodynamic data are not available for this population. METHODS: We conducted a prospective multicenter study in 226 patients with HCV-related cirrhosis and CSPH who achieved SVR after antiviral therapy. Patients with CSPH 24 weeks after end of treatment (SVR24) were offered another hemodynamic assessment 96 weeks after end of treatment (SVR96). RESULTS: All patients were clinically evaluated. Out of 176 patients with CSPH at SVR24, 117 (66%) underwent an HVPG measurement at SVR96. At SVR96, 55/117 (47%) patients had HVPG <10 mmHg and 53% had CSPH (65% if we assume persistence of CSPH in all 59 non-evaluated patients). The proportion of high-risk patients (HVPG ≥16 mmHg) diminished from 41% to 15%. Liver stiffness decreased markedly after SVR (median decrease 10.5 ± 13 kPa) but did not correlate with HVPG changes (30% of patients with liver stiffness measurement <13.6 kPa still had CSPH). Seventeen (7%) patients presented with de novo/additional clinical decompensation, which was independently associated with baseline HVPG ≥16 mmHg and history of ascites. CONCLUSIONS: Patients achieving SVR experienced a progressive reduction in portal pressure during follow-up. However, CSPH may persist in up to 53-65% of patients at SVR96, indicating persistent risk of decompensation. History of ascites and high-risk HVPG values identified patients at higher risk of de novo or further clinical decompensation. LAY SUMMARY: As a major complication of cirrhosis, clinically significant portal hypertension (CSPH) is associated with adverse clinical outcomes. Herein, we show that CSPH persists at 96 weeks in just over half of patients with HCV-related cirrhosis, despite HCV elimination by direct-acting antivirals. Despite viral cure, patients with CSPH at the start of antiviral treatment remain at long-term risk of hepatic complications and should be managed accordingly.
BACKGROUND & AIMS: Clinically significant portal hypertension (CSPH), defined as a hepatic venous pressure gradient (HVPG) ≥10 mmHg, persists 24 weeks after sustained virological response (SVR) in up to 78% of patients with HCV-related cirrhosis treated with direct-acting antivirals. These patients remain at risk of decompensation. However, long-term paired clinical and hemodynamic data are not available for this population. METHODS: We conducted a prospective multicenter study in 226 patients with HCV-related cirrhosis and CSPH who achieved SVR after antiviral therapy. Patients with CSPH 24 weeks after end of treatment (SVR24) were offered another hemodynamic assessment 96 weeks after end of treatment (SVR96). RESULTS: All patients were clinically evaluated. Out of 176 patients with CSPH at SVR24, 117 (66%) underwent an HVPG measurement at SVR96. At SVR96, 55/117 (47%) patients had HVPG <10 mmHg and 53% had CSPH (65% if we assume persistence of CSPH in all 59 non-evaluated patients). The proportion of high-risk patients (HVPG ≥16 mmHg) diminished from 41% to 15%. Liver stiffness decreased markedly after SVR (median decrease 10.5 ± 13 kPa) but did not correlate with HVPG changes (30% of patients with liver stiffness measurement <13.6 kPa still had CSPH). Seventeen (7%) patients presented with de novo/additional clinical decompensation, which was independently associated with baseline HVPG ≥16 mmHg and history of ascites. CONCLUSIONS:Patients achieving SVR experienced a progressive reduction in portal pressure during follow-up. However, CSPH may persist in up to 53-65% of patients at SVR96, indicating persistent risk of decompensation. History of ascites and high-risk HVPG values identified patients at higher risk of de novo or further clinical decompensation. LAY SUMMARY: As a major complication of cirrhosis, clinically significant portal hypertension (CSPH) is associated with adverse clinical outcomes. Herein, we show that CSPH persists at 96 weeks in just over half of patients with HCV-related cirrhosis, despite HCV elimination by direct-acting antivirals. Despite viral cure, patients with CSPH at the start of antiviral treatment remain at long-term risk of hepatic complications and should be managed accordingly.
Authors: Lucia Cerrito; Maria Elena Ainora; Alberto Nicoletti; Matteo Garcovich; Laura Riccardi; Maurizio Pompili; Antonio Gasbarrini; Maria Assunta Zocco Journal: World J Hepatol Date: 2021-11-27
Authors: Sara Cuesta-Sancho; Mercedes Márquez-Coello; Francisco Illanes-Álvarez; Denisse Márquez-Ruiz; Ana Arizcorreta; Fátima Galán-Sánchez; Natalia Montiel; Manuel Rodriguez-Iglesias; José-Antonio Girón-González Journal: World J Hepatol Date: 2022-01-27
Authors: Mariana Sandoval Lourenço; Patricia Momoyo Y Zitelli; Marlone Cunha-Silva; Arthur Ivan N Oliveira; Roque Gabriel Rezende de Lima; Evandro de Oliveira Souza; Claudia P Oliveira; Tiago Sevá-Pereira; Flair J Carrilho; Mario G Pessoa; Daniel F Mazo Journal: Clinics (Sao Paulo) Date: 2021-11-19 Impact factor: 2.365
Authors: Mathias Jachs; Lukas Hartl; David Bauer; Benedikt Simbrunner; Albert Friedrich Stättermayer; Robert Strassl; Michael Trauner; Mattias Mandorfer; Thomas Reiberger Journal: J Pers Med Date: 2022-02-08