Liver Volume as a Predictor of Functional Improvement Post-DAA Treatment

New direct antiviral agents (DAA) for hepatitis C virus treatment result in sustained virologic response (SVR) in most patients. However, predicting the point of no return is still an unmet need for those with advanced liver disease. The aim is to assess if baseline liver volume is a predictor of post-SVR liver function.

Cirrhotic patients assessed for liver transplantation and consecutively treated with DAA between September 2014 and 2015 who achieved an SVR were included. Pretreatment liver volume (LV) and spleen volume (SV) adjusted by body surface area (BSA) were calculated from computed tomography/magnetic resonance images. Liver function was assessed by Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores, and a multivariable mixed regression model was used to identify baseline factors associated with improvement of liver function overtime.

We included 42 patients with a median age of 58.6 years (first quartile to third quartile, 52.7-68.8); MELD, 14 (11-17); CTP, 9 (8-10); LV, 1400.9 mL (1183.2-1601.4); SV, 782.9 mL (490.6-1118.8). MELD scores at baseline and at last control were 14 (11-17) and 10 (8-12), respectively (P < 0.001); CTP scores were 9 (8-10) and 6 (5-7), respectively (P < 0.001). In the multivariable model, higher LV/BSA was associated with an improvement of MELD and CTP over time (P = 0.03 and P = 0.044, respectively).

LV is a noninvasive tool that can predict functional improvement in cirrhotic patients undergoing DAA therapies.