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Improved Liver Function After Sustained Virologic Response Enhanced Prognosis in Hepatitis C with Compensated Advanced Liver Fibrosis

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Abstract

Background and Aim

Liver function can be improved in patients with chronic hepatitis C virus (HCV) infection who achieved sustained virologic response (SVR) with direct-acting antiviral (DAA) treatment. However, to our knowledge, the impact of liver function improvement after SVR on prognosis has not been investigated.

Methods

A total of 716 patients with chronic HCV infection and compensated advanced liver fibrosis who began receiving DAA treatment between September 2014 and August 2018 in 25 Japanese hospitals and achieved SVR were enrolled.

Results

The median age was 73 years, and 336 (47%) and 380 (53%) patients had albumin-bilirubin (ALBI) grade 1 and grade 2, respectively. Improvement to ALBI grade 1 at 1 year after the end of treatment (EOT) was observed in 76% of the patients with baseline ALBI grade 2. Among 380 patients with baseline ALBI grade 2, alanine aminotransferase (ALT) levels ≥ 40 U/L (p < 0.001) and modified ALBI (mALBI) grade 2a (p < 0.001) were significantly associated with improvement to ALBI grade 1 at 1 year after EOT in multivariate analysis. During the median observation period of 51.8 months, 4 and 10 patients with baseline ALBI grade 1 and 2, respectively, died. In patients with baseline ALBI grade 2, only the absence of improvement to ALBI grade 1 at 1 year after EOT was significantly associated with all-cause mortality in univariate analysis.

Conclusions

Baseline ALT levels and mALBI grade were significantly associated with improvement in liver function after SVR. Patients whose liver function improved after SVR could have better prognosis.

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Abbreviations

ALBI:

Albumin-bilirubin

ALT:

Alanine aminotransferase

ASV:

Asunaprevir

BMI:

Body mass index

CCC:

Cholangiocellular carcinoma

CT:

Computed tomography

DAA:

Direct-acting antiviral

DCV:

Daclatasvir

EBR:

Elbasvir

EOT:

End of treatment

FIB-4:

Fibrosis-4

GLE:

Glecaprevir

GZR:

Grazoprevir

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

LDV:

Ledipasvir

MRI:

Magnetic resonance imaging

OBV:

Ombitasvir

PIB:

Pibrentasvir

PTV:

Paritaprevir

RBV:

Ribavirin

SOF:

Sofosbuvir

SVR:

Sustained virologic response

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Acknowledgments

Other institutions attending the Osaka Liver Forum were as follows: Nishinomiya Municipal Central Hospital (Hiroyuki Ogawa), Toyonaka Municipal Hospital (Masami Inada), Kinki Central Hospital of Mutual Aid Association of Public School Teachers (Mitsunari Yamamoto), Itami City Hospital (Kazuho Imanaka), Hyogo Prefectural Nishinomiya Hospital (Sadaharu Iio), Saso Hospital (Meiko Nishiuchi), Higashiosaka City Medical Center (Takatoshi Nawa), Sumitomo Hospital (Akira Yamada), NTT West Osaka Hospital (Msanori Miyazaki), Saiseikai Senri Hospital (Eiji Masuda), and Ashiya Municipal Hospital (Takeo Usui).

Funding

This study was partially supported by grants from Gilead Sciences, Inc., and a Grant-in-Aid for Research from the Japan Agency for Medical Research and Development (20fk0210064h, T.T., R.S., and H.H.; 20fk0210067, R.S.).

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Yuki Tahata, Ryotaro Sakamori, Ryoko Yamada, Takahiro Kodama, Hayato Hikita, Tomohide Tatsumi & Tetsuo Takehara

  2. Kansai Rosai Hospital, Amagasaki, Hyogo, Japan

    Hideki Hagiwara

  3. Ikeda Municipal Hospital, Ikeda, Osaka, Japan

    Masahide Oshita & Yasuharu Imai

  4. Osaka Rosai Hospital, Sakai, Osaka, Japan

    Naoki Hiramatsu

  5. National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan

    Eiji Mita

  6. Minoh City Hospital, Minoh, Osaka, Japan

    Akira Kaneko

  7. Osaka Police Hospital, Osaka, Osaka, Japan

    Masanori Miyazaki

  8. Osaka International Cancer Institute, Osaka, Osaka, Japan

    Kazuyoshi Ohkawa

  9. National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Osaka, Japan

    Taizo Hijioka

  10. Yao Municipal Hospital, Yao, Osaka, Japan

    Hiroyuki Fukui

  11. Japan Community Healthcare Organization Osaka Hospital, Osaka, Osaka, Japan

    Toshifumi Ito

  12. National Hospital Organization Minami Wakayama Medical Center, Tanabe, Wakayama, Japan

    Keiji Yamamoto

  13. Otemae Hospital, Osaka, Osaka, Japan

    Yoshinori Doi

  14. Suita Municipal Hospital, Suita, Osaka, Japan

    Yuichi Yoshida

  15. Kaizuka City Hospital, Kaizuka, Osaka, Japan

    Yukinori Yamada

  16. Osaka General Medical Center, Osaka, Osaka, Japan

    Takayuki Yakushijin

Authors
  1. Yuki Tahata
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  2. Ryotaro Sakamori
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  3. Ryoko Yamada
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  18. Yoshinori Doi
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  19. Yuichi Yoshida
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  20. Yukinori Yamada
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  21. Takayuki Yakushijin
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  22. Tomohide Tatsumi
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  23. Tetsuo Takehara
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Osaka Liver Forum

Corresponding author

Correspondence to Tetsuo Takehara.

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Conflict of interest

Tetsuo Takehara received research grants from Gilead Sciences, Inc., Chugai Pharmaceutical Co., Ltd., MSD K. K., and Abbvie Inc., and was on the speakers’ bureau for Gilead Sciences, Inc., MSD K. K., and Abbvie Inc. All other authors have no conflicts of interest to disclose.

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Tahata, Y., Sakamori, R., Yamada, R. et al. Improved Liver Function After Sustained Virologic Response Enhanced Prognosis in Hepatitis C with Compensated Advanced Liver Fibrosis. Dig Dis Sci 68, 2115–2122 (2023). https://doi.org/10.1007/s10620-022-07629-y

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