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SEMMLERALONSOLOPEZ_LONGTERM_RISK__unificat.2pdf.pdf (622.01 KB)

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2025-02-01

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Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/227774

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

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https://doi.org/10.1097/HEP.0000000000001005

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Background & Rationale: Around 750.000 patients/year will be cured from hepatitis C-virus (HCV)-infection until 2030. Those with compensated advanced chronic liver disease (cACLD) remain at risk for hepatic decompensation and de-novo hepatocellular carcinoma (HCC). Algorithms have been developed to stratify risk early after cure, however, data on long-term outcome and the prognostic utility of these risk stratification algorithms at later timepoints are lacking. Main Results: We retrospectively analysed a cohort of 2335 cACLD-patients (LSM >= 10kPa) who achieved HCV-cure by interferon-free therapies from 15 European centres (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 [IR]: 0.74%/year, cumulative incidence at 6 y: 3.2%); 183 (7.8%) patients developed de-novo HCC (IR: 1.60%/year, cumulative incidence at 6 y: 8.3%), with both risks being strictly linear over time. Baveno VII criteria to exclude (FU-LSM 150 G/L) or rule-in (FU-LSM >= 25kPa) 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 grey-zone (i.e., patients meeting none of the above criteria). Published HCC risk stratification algorithms identified high- and low-incidence groups, however, the size of the latter group varied substantially (9.9%-69.1%). A granular 'HCC-SVR' model was developed to inform on an individual patient's HCC-risk after HCV-cure. Conclusion: In patients with cACLD, 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 non-invasive criteria provides important prognostic information that is maintained during long-term follow-up, as the hazards remain proportional over time.

Matèries

Infeccions per coronavirus, Cirurgia hepàtica, Hepatitis

Matèries (anglès)

Coronavirus infections, Liver surgery, Hepatitis

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Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

Citació

SEMMLER, Georg, et al. Long-term outcome and risk stratification in compensated advanced chronic liver disease after HCV-cure. HEPATOLOGY. 2025. Vol. 81, num. 2, pags. 609-624. ISSN 1527-3350. [consulted: 19 of August of 2026]. Available at: https://hdl.handle.net/2445/227774

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