Background and AimFew studies have evaluated sustained virological response (SVR) rates by direct‐acting agents (DAAs) and liver stiffness measurement (LSM) changing post‐SVR in limited‐resource settings. We aimed to describe the effectiveness of DAAs for hepatitis C virus treatment and to assess the changing of LSM post‐SVR.MethodsThis retrospective study analyzed data of consecutive hepatitis C virus‐infected patients treated by DAAs from 2015 to 2017 in two tertiary centers in Brazil. SVR rates were reported by intention‐to‐treat and per‐protocol analyses. LSM by transient elastography performed before treatment and post‐SVR was compared, and logistic regression models were performed.ResultsSix hundred seventy‐one patients (63% female, 62 years [55–68], 89% genotype 1, 8% HIV co‐infected, and 64% with cirrhosis) were included. Most patients were treated by sofosbuvir/daclatasvir ± ribavirin (74%) and sofosbuvir/simeprevir ± ribavirin (21%). SVR rates (95% confidence interval [CI]) were 94.6% (92.7–96.1) and 97.8% (96.4–98.7) for intention‐to‐treat and per‐protocol analyses, respectively. The leading adverse event was anemia (9.6% [95% CI 7.6–12.1]). Pretreatment and post‐SVR12 LSM were available in 400 patients. LSM had significantly decreased after SVR (13.6 kPa [interquartile range, 10.0–21.6] vs 10.2 kPa [7.0–17.6], P < 0.001). A total of 167 patients (42%) decreased at least 30% of LSM post‐SVR. The absence of type 2 diabetes (odds ratio = 1.52 [95% CI 1.05–2.21], P = 0.028) and presence of platelet count ≥ 150 × 109/mm3 (odds ratio = 1.75 [1.23–2.50], P = 0.002) were independently associated with a significant LSM regression (≥ 30%) post‐SVR.ConclusionDAAs were highly effective and safe, and LSM significantly decreased after SVR in a real‐life cohort in Brazil. The absence of type 2 diabetes and presence of high platelet count were independently associated with LSM decrease post‐SVR.

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The role of liver stiffness measurement (LSM) after sustained virological response (SVR) in HCV patients treated by direct-acting antivirals (DAAs) remains unclear. We aimed to evaluate LSM regression value after SVR and to identify risk factors associated with liver related complications (LRC) or death. This retrospective study analyzed patients with LSM ≥ 10 kPa with LSM by transient elastography pre-DAAs and post-SVR. Patients with previous hepatic decompensation were excluded. Medical records were reviewed to identify primary outcomes. Kaplan–Meier curves and time-to-event Cox proportional-hazard models were performed. 456 patients [65% female, 62 years (IQR 57–68)] were included. During a follow-up of 2.3 years (IQR 1.6–2.7), 28 patients developed 37 outcomes [rate = 29.0 (95% CI 20.0–42.0) per 1000 person-years]. The cumulative incidence of outcomes was significantly lower in patients who regressed LSM ≥ 20% [3.4% (95% CI 1.8–7.0) vs. 9.0% (5.5–14.5), p = 0.028]. In a multivariate Cox-model [HR(95% CI)], male gender [HR = 3.00 (1.30–6.95), p = 0.010], baseline albumin < 3.5 mg/dL [HR = 4.49 (1.95–10.34), p < 0.001] and baseline unfavorable Baveno-VI [HR = 4.72 (1.32–16.83), p = 0.017] were independently associated and LSM regression ≥ 20% after SVR had a trend to reduce the risk of LRC or death [HR = 0.45 (0.21–1.02), p = 0.058]. The use of simple parameters before DAAs and repetition of LSM post-SVR can identify patients with different risks for severe outcome after HCV eradication.

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Coronavirus disease 2019 (COVID-19), an infection caused by severe acute respiratory syndrome coronavirus-type 2 (SARS-CoV-2), has emerged as a serious threat to public health. Liver transplant (LT) recipients may be at increased risk of acquisition of SARS-CoV-2 infection and higher morbidity and mortality due to constant contact with health-care services, the use of immunosuppressants and frequent comorbidities. In the first part of this review we discuss 1) the epidemiology and risk factors for SARS-CoV-2 infection in LT recipients; 2) the clinical and laboratory features of COVID-19 in this specific population, highlighting differences in presenting signs and symptoms with respect to general populations and 3) the natural history and prognostic factors in LT recipients hospitalized with COVID-19, with particular focus on the possible role of immunosuppression. Thereafter, we review the potential therapeutic options for COVID-19 treatment and prevention. Specifically, we give an overview of current practice in immunosuppressant regimen changes, showing the potential benefits of this strategy, and explore safety and efficacy issues of currently approved drugs in LT recipients. The last topic is dedicated to the potential benefits and pitfalls of vaccination.

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Background. Although recently challenged, systemic inflammatory response syndrome (SIRS) criteria are still commonly used in daily practice to define sepsis. However, several factors in liver cirrhosis may negatively impact its prognostic ability. Goals. To investigate the factors associated with the presence of SIRS, the characteristics of SIRS related to infection, and its prognostic value among patients hospitalized for acute decompensation of cirrhosis. Study. In this cohort study from two tertiary hospitals, 543 patients were followed up, up to 90 days. Data collection, including the prognostic models, was within 48 hours of admission. Results. SIRS was present in 42.7% of the sample and was independently associated with upper gastrointestinal bleeding (UGB), ACLF, infection, and negatively related to beta-blockers. SIRS was associated with mortality in univariate analysis, but not in multiple Cox regression analysis. The Kaplan–Meier survival probability of patients without SIRS was 73.0% and for those with SIRS was 64.7%. The presence of SIRS was not significantly associated with mortality when considering patients with or without infection, separately. Infection in SIRS patients was independently associated with Child-Pugh C and inversely related to UGB. Among subjects with SIRS, mortality was independently related to the presence of infection, ACLF, and Child-Pugh C. Conclusions. SIRS was common in hospitalized patients with cirrhosis and was of no prognostic value, even in the presence of infection.

Objective We aimed to evaluate the agreement/accuracy of point shear-wave elastography (p-SWE) and 2D-shear-wave elastography (2D-SWE) for liver fibrosis staging using transient elastography (TE) as the reference. Methods This retrospective study analyzed data from people with chronic liver diseases submitted to TE, p-SWE, and 2D-SWE. Liver fibrosis stages were defined using the TE’s ‘rule of five’: normal (<5 kPa); suggestive of compensated-advanced chronic liver disease (cACLD) (10–15 kPa); highly suggestive of cACLD (15–20 kPa); suggestive of clinically significant portal hypertension (>20 kPa). Agreement and accuracy of p-SWE and 2D-SWE were assessed. Optimal cutoffs for p-SWE and 2D-SWE were identified using the point nearest to the upper left corner of the ROC curves. Results A total of 289 participants were included. The correlation between TE and 2D-SWE (rho = 0.59; P < 0.001) or p-SWE (rho = 0.69; P < 0.001) was satisfactory. The AUROCs (95% CI) of 2D-SWE and p-SWE for TE ≥ 5 kPa; TE ≥ 10 kPa; TE ≥ 15 kPa and TE ≥ 20 kPa were 0.757 (0.685–0.829) and 0.741 (0.676–0.806); 0.819 (0.770–0.868) and 0.870 (0.825–0.915); 0.848 (0.803–0.893) and 0.952 (0.927–0.978); 0.851 (0.806–0.896) and 0.951 (0.920–0.982), respectively. AUROCs of 2D-SWE were significantly lower compared with p-SWE for detecting cACLD. Optimal thresholds of 2D-SWE and p-SWE for TE ≥ 15 kPa were 8.82 kPa (sensitivity = 86% and specificity = 79%) and 8.86 kPa (sensitivity = 90% and specificity = 92%), respectively. Conclusion LSM by p-SWE and 2D-SWE techniques were correlated with TE. LSM by p-SWE seems to be more accurate than 2D-SWE to identify patients with more advanced fibrosis.