Clinical outcome and hemodynamic changes following HCV eradication with oral antiviral therapy in patients with clinically significant portal hypertension
Por:
Lens, S, Baiges, A, Alvarado-Tapias, E, LLop, E, Martinez, J, Fortea, JI, Ibanez-Samaniego, L, Marino, Z, Rodriguez-Tajes, S, Gallego, A, Banares, R, Puente, A, Albillos, A, Calleja, JL, Torras, X, Hernandez-Gea, V, Bosch, J, Villanueva, C, Garcia-Pagan, JC, Forns, X
Publicada:
1 dic 2020
Resumen:
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. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Filiaciones:
Lens, S:
Univ Barcelona, Hosp Clin, Liver Unit, IDIBAPS, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Baiges, A:
Univ Barcelona, Hosp Clin, Liver Unit, IDIBAPS, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Alvarado-Tapias, E:
Hosp Santa Creu & Sant Pau, Gastroenterol Dept, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
LLop, E:
Univ Autonoma Madrid, Hosp Univ Puerta Hierro, Liver Unit, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Martinez, J:
Univ Alcala De Henares, Hosp Univ Ramon y Cajal, Serv Gastroenterol & Hepatol, IRYCIS, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Fortea, JI:
Marques de Valdecilla Univ Hosp, Digest Dis Dept, IDIVAL, Santander, Spain
Ibanez-Samaniego, L:
Univ Complutense Madrid, Hosp Gregorio Maranon, Fac Med, Liver Unit, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Marino, Z:
Univ Barcelona, Hosp Clin, Liver Unit, IDIBAPS, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Rodriguez-Tajes, S:
Univ Barcelona, Hosp Clin, Liver Unit, IDIBAPS, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Gallego, A:
Hosp Santa Creu & Sant Pau, Gastroenterol Dept, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Banares, R:
Univ Complutense Madrid, Hosp Gregorio Maranon, Fac Med, Liver Unit, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Puente, A:
Marques de Valdecilla Univ Hosp, Digest Dis Dept, IDIVAL, Santander, Spain
Albillos, A:
Univ Alcala De Henares, Hosp Univ Ramon y Cajal, Serv Gastroenterol & Hepatol, IRYCIS, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Calleja, JL:
Univ Autonoma Madrid, Hosp Univ Puerta Hierro, Liver Unit, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Torras, X:
Hosp Santa Creu & Sant Pau, Gastroenterol Dept, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hernandez-Gea, V:
Univ Barcelona, Hosp Clin, Liver Unit, IDIBAPS, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Bosch, J:
Univ Barcelona, Hosp Clin, Liver Unit, IDIBAPS, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Bern Univ, Inselspital, Hepatol, Bern, Switzerland
Villanueva, C:
Hosp Santa Creu & Sant Pau, Gastroenterol Dept, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Garcia-Pagan, JC:
Univ Barcelona, Hosp Clin, Liver Unit, IDIBAPS, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Forns, X:
Univ Barcelona, Hosp Clin, Liver Unit, IDIBAPS, Barcelona, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
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