Journal of Hepatology
Volume 59, Issue 2 , Pages 251-256, August 2013
Received 12 December 2012; received in revised form 5 March 2013; accepted 8 March 2013. published online 25 March 2013.
Background & Aims
Transient elastography (TE) is a validated non-invasive tool to evaluate hepatic fibrosis in patients with hepatitis C virus (HCV) infection. Whether TE may sense changes of liver fibrosis following therapeutic HCV eradication has never been evaluated.
37 HCV cirrhotics with paired pre- and post-sustained virological response (SVR) liver biopsies (LB) underwent TE at the time of post-SVR LB. Liver fibrosis was staged with the METAVIR scoring system and the area of fibrosis (%) was assessed morphometrically.
Thirty-three patients had valid TE measurements after 61 (48–104) months from an SVR, and 20 (61%) of them had cirrhosis regression. On post-SVR LB, the median area of fibrosis was 2.3%, being significantly reduced from baseline (p<0.0001). Median TE value was 9.8kPa being lower in regressed vs. not regressed patients (9.1kPa vs. 12.9kPa, p=0.01). TE was <12kPa in 5 (38%) F4 patients and in 19 (95%) F3 patients (p=0.0007). The diagnostic accuracy of TE for diagnosing F4 after treatment was 61% sensitivity, 95% specificity, 12.3 LR+, 0.4 LR−, and AUROC 0.77. A significant correlation was found between TE and both fibrosis stage (r=0.56; p=0.001) and morphometry (r=0.56, p=0.001) as well as between fibrosis stage and area of fibrosis (r=0.72, p=0001).
Following therapeutic eradication of HCV, the predictive power of the viremic cut-off of 12kPa was low as a consequence of liver remodelling and fibrosis reabsorption. LB still remains the only reliable approach to stage liver fibrosis following an SVR.
Abbreviations: SVR, sustained virological response, IFN, interferon, HCV, hepatitis C virus, HBV, hepatitis B virus, LB, liver biopsy, TE, transient elastography, LS, liver stiffness, RBV, ribavirin, LSM, liver stiffness measurement, IQR, interquartile ratio, CI, confidence interval, LR, likelihood ratio