Ravaioli F, Colecchia A, Dajti E, Marasco G, Alemanni LV, Tamè M, Azzaroli F, Brillanti S, Mazzella G, Festi D. Spleen stiffness mirrors changes in portal hypertension after successful interferon-free therapy in chronic-hepatitis C virus patients. World J Hepatol 2018; 10(10): 731-742 [PMID: 30386466 DOI: 10.4254/wjh.v10.i10.731]
Corresponding Author of This Article
Antonio Colecchia, MD, Unit of Gastroenterology, Borgo Trento University Hospital, Verona 37100, Italy. antonio.colecchia@aovr.veneto.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Oct 27, 2018; 10(10): 731-742 Published online Oct 27, 2018. doi: 10.4254/wjh.v10.i10.731
Spleen stiffness mirrors changes in portal hypertension after successful interferon-free therapy in chronic-hepatitis C virus patients
Federico Ravaioli, Antonio Colecchia, Elton Dajti, Giovanni Marasco, Luigina Vanessa Alemanni, Mariarosa Tamè, Francesco Azzaroli, Stefano Brillanti, Giuseppe Mazzella, Davide Festi
Federico Ravaioli, Antonio Colecchia, Elton Dajti, Giovanni Marasco, Luigina Vanessa Alemanni, Mariarosa Tamè, Francesco Azzaroli, Stefano Brillanti, Giuseppe Mazzella, Davide Festi, Gastroenterology Unit, Sant’Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy
Antonio Colecchia, Unit of Gastroenterology, Borgo Trento University Hospital, Verona 37100, Italy
Author contributions: Ravaioli F, Dajti E, Marasco G and Alemanni V collected data, analysed data, wrote the manuscript, approved the final manuscript; Tamè M, Azzaroli F, Brillanti S and Mazzella G analysed data and contributed to the drafting and final approval of the manuscript; Colecchia A, Mazzella G and Festi D provided overall oversight of the study, analysed data and contributed to the drafting and final approval of the manuscript.
Institutional review board statement: This study was approved by the National Institutional Review Board of the Italian Medicines Agency Committee. Local IRB [Institutional Ethics Committee of Sant’Orsola-Malpighi University Hospital (Bologna, Italy)] approval was authorized.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
STROBE statement: The guidelines of the STROBE statement have been adopted and a fulfilled version of the checklist has been attached with the submission of the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonio Colecchia, MD, Unit of Gastroenterology, Borgo Trento University Hospital, Verona 37100, Italy. antonio.colecchia@aovr.veneto.it
Telephone: +39-335-5876834 Fax: +39-51-2144111
Received: July 3, 2018 Peer-review started: July 3, 2018 First decision: July 24, 2018 Revised: July 27, 2018 Accepted: August 12, 2018 Article in press: August 13, 2018 Published online: October 27, 2018 Processing time: 116 Days and 14.5 Hours
ARTICLE HIGHLIGHTS
Research background
The long-term benefits of achieving sustained virological response (SVR) in cirrhotic patients are still to be established. Non-invasive tests (NITs), such as liver (LSM) and especially spleen stiffness (SSM), are widely validated in hepatology as portal hypertension (PH) surrogates. However, their use in SVR patients and their changes after virus eradication is still under discussion.
Research motivation
Many studies have reported rapid LSM decrease after achieving SVR. However, only a few have investigated changes in SSM in such patients, with contrasting results. Given that there is a decrease in SSM after therapy, it means that SSM could be exploited to assess changes in PH and PH-driven complication after achieving SVR.
Research objectives
The main objective of the study was to investigate changes in PH after successful eradication of HCV infection, as reflected by its non-invasive assessment by SSM and other NITs.
Research methods
This is a retrospective study of prospectively collected data. Patients with available paired SSM assessment at baseline and 6 mo after end-of-therapy (SVR24) were included in the study.
Research results
Our main result is that a significant SSM decrease at SVR24 was demonstrated in a large cohort of 134 patients. This is the first study that also reveals a decrease in LSPS after SVR. SSM reduction differed according to the patient’s clinical condition, especially when divided by the presence of clinically significant PH. An LSM decrease of > 20% was evident in the majority of patients, and also in patients in whom no SSM reduction was present. This finding likely reflects the reduction in liver necro-inflammation rather than PH improvement.
Research conclusions
PH, reflected by NITs, improves after achieving SVR in cirrhotic patients. SSM is a direct surrogate of PH and less influenced by liver necro-inflammation, as opposed to LSM. Its decrease (> 20%) could help the clinician to stratify the risk for PH-related complication after DAA therapy.
Research perspectives
Future prospective studies should investigate whether changes in SSM are predictive of clinical decompensation or other complications of cirrhosis after viral eradication. SSM could become a helpful and accurate method to assess therapy response and the risk of complications.
