Short-term hepatocyte function and portal hypertension outcomes of sofosbuvir/velpatasvir for decompensated hepatitis C-related cirrhosis

Abstract

Background It is unclear whether hepatocyte function and/or portal hypertension improves if a sustained virologic response (SVR) is achieved with direct-acting antivirals in patients with decompensated hepatitis C-related cirrhosis. Methods We examined the safety and efficacy of a 12-week course of sofosbuvir/velpatasvir (SOF/VEL) in 20 patients with decompensated hepatitis C-related cirrhosis. We also investigated changes in the hepatocyte receptor index (LHL15) and blood clearance index (HH15) by Tc-99 m-galactosyl human serum albumin scintigraphy, liver stiffness measurement (LSM) by transient elastography, and hepatic venous pressure gradient (HVPG) in patients who achieved an SVR at 24 weeks after treatment (SVR24). Results One patient discontinued treatment because of rectal variceal hemorrhage, and 19 patients completed treatment. SVR24 was achieved in 17 patients (89%). Median LHL15 increased from 0.72 pre-treatment to 0.82 after SVR24 (p = 0.012), and median HH15 decreased from 0.82 pre-treatment to 0.76 after SVR24 (p = 0.010). The percentage of patients with LSM ≥ 20 kPa was 90% before treatment and remained at 90% after SVR24. However, the percentage with severe portal hypertension (defined as HVPG ≥ 12 mmHg) decreased from 92% pre-treatment to 58% after SVR24 (p = 0.046). Patients with a decreased HVPG from pre-treatment to after SVR24 had a smaller pre-treatment spleen volume than those with an increased HVPG (median, 252 vs. 537 mL, p = 0.028). Conclusion Achieving SVR24 with SOF/VEL treatment in patients with decompensated hepatitis C-related cirrhosis can be expected to improve hepatocyte function and portal hypertension on short-term follow-up.

Significance of portal venous blood flow as a factor to determine liver function in patients with decompensated cirrhosis due to hepatitis C virus infection following achievement of sustained viral response by sofosbuvir plus velpatasvir

“…This observation was consistent with previous observations by Atsukawa et al 14 and Sano et al 15 Kotani et al reported that the function of hepatocytes improved after achieving SVR in patients with decompensated cirrhosis using Tc-99m-galactosyl human serum albumin scintigraphy. 16 However, the liver function did not improve in a half of the patients despite of achievement of SVR, and the reason for such phenomenon was uncertain. Thus, in the present study, we evaluated liver function as well as portal hypertension-related…”

“…Kotani et al. reported that the function of hepatocytes improved after achieving SVR in patients with decompensated cirrhosis using Tc‐99m‐galactosyl human serum albumin scintigraphy 16 . However, the liver function did not improve in a half of the patients despite of achievement of SVR, and the reason for such phenomenon was uncertain.…”

Recent Advances in the Pathogenesis and Clinical Evaluation of Portal Hypertension in Chronic Liver Disease

“…In the most recent report, DAA treatment of patients with hepatitis C-related decompensated cirrhosis improved the hepatic accumulation rate of Tc-99m-galactosyl human serum albumin and decreased the percentage of patients with severe portal hypertension (i.e., HVPG ≥12 mm Hg) from 92% to 58%; however, the HVPG did not decrease in patients with large splenic volume. 132 Therefore, in patients with hepatitis C-related cirrhosis and achieve SVR, HVPG decreases in the short term, but CSPH persists in many patients.…”