Long-term outcome and risk stratification in compensated advanced chronic liver disease after HCV-cure.

Autor:	Semmler G; Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.; Vienna Hepatic Hemodynamic Lab, Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria., Alonso López S; Liver Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Instituto De Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.; Universidad Complutense de Madrid, Madrid, Spain., Pons M; Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain., Lens S; Liver Unit, Hospital Clínic, IDIBAPS-FCRB, Universitat de Barcelona, Barcelona, Spain.; Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain., Dajti E; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.; IRCCS Azienda Ospedaliero-Universitaria di Bologna, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Bologna, Italy., Griemsmann M; Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany., Zanetto A; Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy., Burghart L; Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.; Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria., Hametner-Schreil S; Department of Internal Medicine IV, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria., Hartl L; Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.; Vienna Hepatic Hemodynamic Lab, Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria., Manzano M; Liver Unit, Hospital Universitario 12 De Octubre, Madrid, Spain., Rodriguez-Tajes S; Liver Unit, Hospital Clínic, IDIBAPS-FCRB, Universitat de Barcelona, Barcelona, Spain.; Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain., Zanaga P; Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy., Schwarz M; Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.; Vienna Hepatic Hemodynamic Lab, Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.; Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria., Gutierrez ML; Gastroenterology Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain., Jachs M; Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.; Vienna Hepatic Hemodynamic Lab, Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria., Pocurull A; Liver Unit, Hospital Clínic, IDIBAPS-FCRB, Universitat de Barcelona, Barcelona, Spain.; Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain., Polo B; Gastroenterology Unit, Hospital Universitario Fundación Jimenez Díaz, Madrid, Spain., Ecker D; Department of Internal Medicine IV, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria., Mateos B; Liver Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain., Izquierdo S; Gastroenterology Unit, Hospital Universitario Clínico San Carlos, Madrid, Spain., Real Y; Gastroenterology Unit, Hospital Universitario La Princesa, Madrid, Spain., Balcar L; Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.; Vienna Hepatic Hemodynamic Lab, Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria., Carbonell-Asins JA; Biostatistics Unit, Biomedical Research Institute INCLIVA, Valencia, Spain., Gschwantler M; Department of Internal Medicine IV, Klinik Ottakring, Vienna, Austria., Russo FP; Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy., Azzaroli F; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy.; IRCCS Azienda Ospedaliero-Universitaria di Bologna, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Bologna, Italy., Maasoumy B; Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany., Reiberger T; Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.; Vienna Hepatic Hemodynamic Lab, Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria., Forns X; Liver Unit, Hospital Clínic, IDIBAPS-FCRB, Universitat de Barcelona, Barcelona, Spain.; Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain., Genesca J; Liver Unit, Vall d'Hebron University Hospital, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.; Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain., Bañares R; Liver Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Instituto De Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.; Universidad Complutense de Madrid, Madrid, Spain., Mandorfer M; Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.; Vienna Hepatic Hemodynamic Lab, Department of Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
Jazyk:	angličtina
Zdroj:	Hepatology (Baltimore, Md.) [Hepatology] 2024 Jul 08. Date of Electronic Publication: 2024 Jul 08.
DOI:	10.1097/HEP.0000000000001005
Abstrakt:	Background and Aims: Around 750,000 patients per year will be cured of HCV infection until 2030. Those with compensated advanced chronic liver disease remain at risk for hepatic decompensation and de novo HCC. Algorithms have been developed to stratify risk early after cure; however, data on long-term outcomes and the prognostic utility of these risk stratification algorithms at later time points are lacking. Approach and Results: We retrospectively analyzed a cohort of 2335 patients with compensated advanced chronic liver disease (liver stiffness measurement≥10 kPa) who achieved HCV-cure by interferon-free therapies from 15 European centers (median age 60.2±11.9 y, 21.1% obesity, 21.2% diabetes).During a median follow-up of 6 years, first hepatic decompensation occurred in 84 patients (3.6%, incidence rate: 0.74%/y, cumulative incidence at 6 y: 3.2%); 183 (7.8%) patients developed de novo HCC (incidence rate: 1.60%/y, cumulative incidence at 6 y: 8.3%), with both risks being strictly linear over time.Baveno VII criteria to exclude (FU-liver stiffness measurement <12 kPa and follow-up platelet count >150 g/L) or rule-in (FU-liver stiffness measurement ≥25 kPa) clinically significant portal hypertension (CSPH) stratified the risk of hepatic decompensation with proportional hazards. Estimated probability of CSPH discriminated patients developing versus not developing hepatic decompensation in the gray zone (ie, patients meeting none of the above criteria).Published HCC risk stratification algorithms identified high-incidence and low-incidence groups; however, the size of the latter group varied substantially (9.9%-69.1%). A granular "HCC-sustained virologic response" model was developed to inform an individual patient's HCC risk after HCV-cure. Conclusions: In patients with compensated advanced chronic liver disease, the risks of hepatic decompensation and HCC remain constant after HCV-cure, even in the long term (>3 y). One-time post-treatment risk stratification based on noninvasive criteria provides important prognostic information that is maintained during long-term follow-up, as the hazards remain proportional over time. (Copyright © 2024 American Association for the Study of Liver Diseases.)
Databáze:	MEDLINE
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