Evolution of liver stiffness and post-treatment surveillance by liver elastography for HCV patients in the DAA era

Abstract

Objective

Baseline liver stiffness (LS) is prognostically relevant in patients with chronic hepatitis C virus (HCV) infection but may change after successful HCV eradication. Data on post-treatment LS for a further risk stratification remain scarce. Here, we study the kinetics of LS and laboratory parameters in patients undergoing HCV treatment and analyze the association of post-treatment LS with outcome parameters.

Methods

In a cohort of 1011 chronic HCV patients undergoing DAA treatment, we identified 404 patients with sequential LS and laboratory assessments with or without viral eradication. Additionally, outcome parameters were correlated with post-treatment LS after successful HCV therapy.

Results

LS significantly decreased from a median of 8.8 to 6.1 kPa in 346 patients after HCV eradication, but significantly increased from a median of 10.5 to 11.9 kPa in 58 patients without viral clearance. In 78 patients with two sequential post-treatment measurements, LS decreased from 12.6 to 8.7 kPa after a median 344 d, with a further decrease to 7.0 kPa after a median of 986 d after end of treatment (EoT). In 400 patients with a post-treatment LS assessment after viral eradication, only 9 liver-related events occurred over a median follow-up (FU) of 23 months. All events were observed in patients with a post-treatment LS >20 kPa.

Conclusions

After successful HCV eradication, LS improves sequentially, suggesting an initial phase of necroinflammation regression followed by a second phase of true fibrosis regression. Overall, liver-related events were rarely observed and seem to be limited to patients with a post-treatment LS >20 kPa, so that these patients require a closer clinical monitoring.

Keywords:

• Transient elastography
• liver cirrhosis
• viral hepatitis
• sustained virological response
• portal hypertension
• direct-acting antivirals

Author contributions

F.P.: design of the study, data acquisition, statistical analysis and interpretation of the data and writing the paper. J.M.G.: design of the study, data acquisition, interpretation of the data and critical reading. A.K.O.: statistical analysis and critical reading. M.H.W.: design of the study and critical reading. J.K.: interpretation of the data and critical reading. S.L.: interpretation of the data and critical reading. A.M.C.: interpretation of the data and critical reading. G.B.: interpretation of the data and critical reading. T.H.: interpretation of the data and critical reading. M.S.: interpretation of the data and critical reading. S.P.: interpretation of the data and critical reading. A.W.L.: interpretation of the data and critical reading. J.S.W.: conception and design, writing the paper, critical reading and final approval.

Disclosure statement

S.P. reports personal fees from AbbVie and Merck/MSD, J.S.Z.W. has received personal fees from AbbVie, Gilead and Merck/MSD. For the remaining authors, none were declared for the publication under consideration.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and its Supplementary materials.