Abstract
Aims: The purpose of this study was to assess the changes in hepatic morphology evaluated by computed tomography (CT) examination in patients with hepatitis C virus (HCV)-related compensated cirrhosis who achieved sustained virologic response (SVR) after direct-acting antivirals (DAAs) treatment. Methods: CT examination was performed in 56 patients with HCV-related compensated cirrhosis before and within 6–18 months after the treatment with Ombitasvir/Paritaprevir/ritonavir + Dasabuvir. The liver CT changes were assessed by measuring liver volume, caudate-right lobe ratio (C/RL), hepatic vessels diameters, periportal widening space, and right posterior notch. Portal trunk, splenic and superior mesenteric vein diameters, as well as spleen volume were assessed as part of portal hypertension. Results: Right hepatic vein diameter was significantly wider after treatment (median: 8.12 mm; IQR: 4.20) than before treatment (median: 6.36 mm; IQR: 3.94) z = −3.894; p < 0.001. The liver volume was significantly higher prior to the treatment (median: 1786.77 mm3; IQR: 879.23) than after treatment (median: 1716.44 mm3; IQR: 840.50), z = −1.970; p = 0.049. Splenic volume was considerably higher before treatment (median: 564.79 mm3; IQR: 342.54) than after (median: 474.45 mm3; IQR: 330.00), z = −2.500; p = 0.012. The other parameters, such as C/RL, periportal space widening, and right hepatic notch showed no significant changes. Conclusions: SVR in patients with HCV-related compensated cirrhosis treated with DAAs is associated with some improvements of hepatic morphology detectable by CT, the most constant being the increase of right hepatic vein diameter.
Highlights
Liver cirrhosis is a major cause of morbidity and mortality worldwide and is currently the 11th most common cause of death on a global scale, accounting for 3.5% of all deaths [1]
This is a prospective study on patients with genotype 1 hepatitis C virus (HCV)-related compensated cirrhosis who have achieved sustained virologic response (SVR) after treatment with direct-acting antivirals (DAAs) (Ombitasvir/Paritaprevir/ritonavir+ Dasabuvir)
Insurance Agency and recommended by international guidelines: adult, treatment experienced or naïve patients with Child–Pugh class A cirrhosis assessed by Fibromax® Biopredictive or liver biopsy (F4 by METAVIR)
Summary
Liver cirrhosis is a major cause of morbidity and mortality worldwide and is currently the 11th most common cause of death on a global scale, accounting for 3.5% of all deaths [1]. One of the main causes of cirrhosis is the infection with hepatitis C virus (HCV) [2]. Cirrhosis was considered an irreversible end stage of liver disease, mostly due to lack of treatment possibilities. Nowadays, this irreversibility is no longer considered a “dogma” as liver fibrosis is potentially reversible on the condition that the trigger is removed [6]. There is evidence that patients who achieve SVR are less likely to develop liver-related complications, due to the regression of fibrosis after HCV eradication [7]. Several non-invasive methods for assessing liver fibrosis confirmed fibrosis regression in patients with SVR [8,9,10]
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