Published online Oct 27, 2018. doi: 10.4254/wjh.v10.i10.731
Peer-review started: July 3, 2018
First decision: July 24, 2018
Revised: July 27, 2018
Accepted: August 12, 2018
Article in press: August 13, 2018
Published online: October 27, 2018
To investigate changes in spleen stiffness measurements (SSMs) and other non-invasive tests (NITs) after treatment with direct-acting antivirals (DAAs) and identify predictors of SSM change after sustained virological response (SVR).
We retrospectively analysed 146 advanced-chronic liver disease (ACLD) patients treated with DAA with available paired SSM at baseline and SVR24. Liver stiffness (LSM), spleen diameter (SD), platelet count (PLT) and liver stiffness-spleen diameter to platelet ratio score(LSPS) were also investigated. LSM ≥ 21 kPa was used as a cut-off to rule-in clinically significant portal hypertension (CSPH). SSM reduction > 20% from baseline was defined as significant.
SSM significantly decreased at SVR24, in both patients with and without CSPH; in 44.8% of cases, SSM reduction was > 20%. LSPS significantly improved in the entire cohort at SVR24; SD and PLT changed significantly only in patients without CSPH. LSM significantly decreased in 65.7% of patients and also in 2/3 patients in whom SSM did not decrease. The independent predictor of decreased SSM was median relative change of LSM. CSPH persisted in 54.4% patients after SVR. Delta LSM and baseline SSM were independent factors associated with CSPH persistence.
SSM and other NITs significantly decrease after SVR, although differently according to the patient’s clinical condition. SSM faithfully reflects changes in portal hypertension and could represent a useful NIT for the follow-up of these patients.
Core tip: Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) are widely validated surrogates of portal hypertension (PH) and its complications. Their role in the assessment of therapy response, such as treatment with direct-acting antivirals (DAAs) of hepatitis C virus patients, is still under investigation. We demonstrated in a large cohort that not only LSM, but also SSM, is reduced six months after successful DAA therapy. As opposed to LSM, SSM directly reflects PH and is less influenced by the immediate reduction of liver necro-inflammation. We believe that SSM could represent a helpful tool for the clinician in the follow-up of these patients.