1Liver Unit, Hospital Clínic, IDIBAPS, Barcelona; CIBERehd. SPAIN.
2Liver Unit, Hospital Gregorio Marañón, Madrid; CIBERehd. SPAIN.
3Liver Unit, Hospital Clínic, IDIBAPS, Barcelona.
4Liver Unit, Hospital Ramón y Cajal, Madrid; CIBERehd. SPAIN.
5Liver Unit, Hospital Puerta del Hierro, IDIPHIM, Madrid.
6Liver Unit, Hospital Clínic, IDIBAPS, Barcelona; Barcelona Hepatic Hemodynamic laboratory.
7Liver Unit, Hospital Clínic, IDIBAPS, Barcelona; Barcelona Hepatic Hemodynamic laboratory; CIBERehd. SPAIN.
8Liver Unit, Hospital Clínic, IDIBAPS, Barcelona; Barcelona Hepatic Hemodynamic laboratory; CIBERehd. SPAIN. Electronic address: JCGARCIA@clinic.ub.es.
BACKGROUND & AIMS:
Hepatic venous pressure gradient (HVPG) is associated with risk of liver events in patients with chronic hepatitis C. Antiviral therapies that lead to a sustained virologic response (SVR) reduce portal pressure and prevent liver disease progression. However, it is not clear to what extent the progression of hepatitis C is modified once patients develop cirrhosis with severe portal hypertension (CSPH, HVPG≥10 mmHg). We assessed the effects of HVPG and SVR on the risk of liver decompensation, hepatocellular carcinoma, and/or death in patients with hepatitis C-related cirrhosis.
We collected data from 100 patients with hepatitis C and compensated cirrhosis who underwent HVPG measurement ≤3 months before (baseline) and 24 weeks after therapy with pegylated interferon alfa-2a and ribavirin at 4 hospitals in Spain, from 2001 through 2009. SVR was defined as undetectable serum HCV RNA 24 weeks after treatment ended. Clinical data were collected until death, liver transplantation, or December 2012 (median 5 y; interquartile range, 1.4-7 y).
Seventy-four patients had CSPH at baseline and 35% of patients achieved an SVR. During the follow-up period, 19 patients developed liver decompensation (ascites, variceal bleeding, or encephalopathy). The actuarial probability values for liver decompensation at 1, 5, and 7 years were 3%, 19% and 22%, respectively. Baseline level of HVPG, but not SVR, was independently associated to the risk of liver decompensation.
Patients with CSPH, regardless of an SVR to therapy for hepatitis C, remain at risk for liver decompensation within the 5 y after treatment; they should be closely monitored.