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
The long-term benefits of achieving sustained virological response (SVR) in cirrhotic patients are still to be established. Non-invasive tests (NITs), such as liver (LSM) and especially spleen stiffness (SSM), are widely validated in hepatology as portal hypertension (PH) surrogates. However, their use in SVR patients and their changes after virus eradication is still under discussion.
Many studies have reported rapid LSM decrease after achieving SVR. However, only a few have investigated changes in SSM in such patients, with contrasting results. Given that there is a decrease in SSM after therapy, it means that SSM could be exploited to assess changes in PH and PH-driven complication after achieving SVR.
The main objective of the study was to investigate changes in PH after successful eradication of HCV infection, as reflected by its non-invasive assessment by SSM and other NITs.
This is a retrospective study of prospectively collected data. Patients with available paired SSM assessment at baseline and 6 mo after end-of-therapy (SVR24) were included in the study.
Our main result is that a significant SSM decrease at SVR24 was demonstrated in a large cohort of 134 patients. This is the first study that also reveals a decrease in LSPS after SVR. SSM reduction differed according to the patient’s clinical condition, especially when divided by the presence of clinically significant PH. An LSM decrease of > 20% was evident in the majority of patients, and also in patients in whom no SSM reduction was present. This finding likely reflects the reduction in liver necro-inflammation rather than PH improvement.
PH, reflected by NITs, improves after achieving SVR in cirrhotic patients. SSM is a direct surrogate of PH and less influenced by liver necro-inflammation, as opposed to LSM. Its decrease (> 20%) could help the clinician to stratify the risk for PH-related complication after DAA therapy.
Future prospective studies should investigate whether changes in SSM are predictive of clinical decompensation or other complications of cirrhosis after viral eradication. SSM could become a helpful and accurate method to assess therapy response and the risk of complications.