Background & Aims
We aimed to investigate the impact of sustained virologic response (SVR) to interferon
(IFN)-free therapies on portal hypertension in patients with paired hepatic venous
pressure gradient (HVPG) measurements.
Methods
One hundred and four patients with portal hypertension (HVPG ⩾6 mmHg) who underwent HVPG and liver stiffness measurement before IFN-free therapy (baseline
[BL]) were retrospectively studied. Among 100 patients who achieved SVR, 60 patients
underwent HVPG and transient elastography (TE) after antiviral therapy (follow-up
[FU]).
Results
SVR to IFN-free therapies significantly decreased HVPG across all BL HVPG strata:
6–9 mmHg (BL: 7.37 ± 0.28 vs. FU: 5.11 ± 0.38 mmHg; −2.26 ± 0.42 mmHg; p <0.001), 10–15 mmHg (BL: 12.2 ± 0.4 vs. FU: 8.91 ± 0.62 mmHg; −3.29 ± 0.59 mmHg; p <0.001) and ⩾16 mmHg (BL: 19.4 ± 0.73 vs. FU: 17.1 ± 1.21 mmHg; −2.3 ± 0.89 mmHg; p = 0.018).
In the subgroup of patients with BL HVPG of 6–9 mmHg, HVPG normalized (<6 mmHg) in 63% (12/19) of patients, while no patient progressed to ⩾10 mmHg. Among patients with BL HVPG ⩾10 mmHg, a clinically relevant HVPG decrease ⩾10% was observed in 63% (26/41); 24% (10/41)
had a FU HVPG <10 mmHg.
Patients with Child-Pugh stage B were less likely to have a HVPG decrease (hazard
ratio [HR]: 0.103; 95% confidence interval [CI]: 0.02–0.514; p = 0.006), when compared to Child-Pugh A patients. In the subgroup of patients with BL
CSPH, the relative change in liver stiffness (per %; HR: 0.972; 95% CI: 0.945–0.999;
p = 0.044) was a predictor of a HVPG decrease ⩾10%.
The area under the receiver operating characteristic curve for the diagnosis of FU
CSPH by FU liver stiffness was 0.931 (95% CI: 0.865–0.997).
Conclusions
SVR to IFN-free therapies might ameliorate portal hypertension across all BL HVPG
strata. However, changes in HVPG seemed to be more heterogeneous among patients with
BL HVPG of ⩾16 mmHg and a HVPG decrease was less likely in patients with more advanced liver dysfunction.
TE might be useful for the non-invasive evaluation of portal hypertension after SVR.
Lay summary
We investigated the impact of curing hepatitis C using novel interferon-free treatments
on portal hypertension, which drives the development of liver-related complications
and mortality. Cure of hepatitis C decreased portal pressure, but a decrease was less
likely among patients with more pronounced hepatic dysfunction. Transient elastography,
which is commonly used for the non-invasive staging of liver disease, might identify
patients without clinically significant portal hypertension after successful treatment.
Graphical abstract
Graphical Abstract
Abbreviations:
HVPG (hepatic venous pressure gradient), ACLD (advanced chronic liver disease), HCV (hepatitis C virus), PegIFN/RBV (pegylated interferon and ribavirin), SVR (sustained virologic response), IFN (interferon), SOF (sofosbuvir), TE (transient elastography), BL (baseline), MELD (model for end-stage liver disease), CP (Child-Pugh), SMV (simeprevir), DCV (daclatasvir), LDV (ledipasvir), NSBB (non-selective beta blocker), CSPH (clinically significant portal hypertension), NPV (negative predictive value), PPV (positive predictive value), AUROC (area under the receiver operating characteristic curve), HCC (hepatocellular carcinoma)Keywords
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Article info
Publication history
Published online: May 27, 2016
Accepted:
May 19,
2016
Received in revised form:
May 17,
2016
Received:
February 7,
2016
Identification
Copyright
© 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
