Portal Hypertension Assessment Spleen using Stiffness Measurements after Successful DAAs Therapy in Chronic-HCV Patients

Abstract

Khaled Elmola, Mohamed Heiza, Ahmed B. Abd El Salam, Basem M. M. Salama

Background: The emergence of noninvasive tests coupled with oral combined DAAs has shifted the paradigm in HCV management. Up to date, it is still questioned if SVR reverse portal hypertension and liver cirrhosis after being treated with direct antiviral therapy.
Aim of the work: To investigate the applicability of using splenic stiffness measurements as indicators of portal hypertension improvement after SVR in patients treated with DAAs.
Methods: This was a prospective study that included 100 HCV patients from Al-Azhar university hospital who achieved SVR after being treated with DAAs. Liver and spleen stiffness measurements as well as biochemical, virologic and clinical data were assessed at baseline (BL), at end of treatment (EOT), 12 weeks post-treatment, and 24 weeks post-treatment. We used Shear wave elastography (SWE) using ultrasound device Aplio 500 system (Toshiba, japan) to assess splenic stiffness.
Results: In our cohort, Spleen stiffness measurements decrease in 58% of the patients. It significantly improved between BL 30.6 kpa (26.3 - 34.8 kPa) and EOT 30.3 kPa (26.2- 34.6 kPa); (P< 0.001), and between BL and 24 weeks post-treatment 30 (26-34.4) kPa. Regarding platelets count, it also improved between BL 205 × 109/L (170- 251 × 109/L) and 24 weeks 218 × 109/L (187- 265 × 109/L); (P< 0.001).
Conclusions: NITs, especially SSM, decrease significantly after SVR in patients treated with DAAs. So that, they can be used as a mirror to reflect changes in portal hypertension status during following-up period instead of other available invasive methods which is well-known for their complications.