Factors involved in gastroesophageal varix-related events in patients with hepatitis C virus-related compensated and decompensated cirrhosis after direct-acting antiviral therapy

Yuki Tahata; Hayato Hikita; Satoshi Mochida; Nobuyuki Enomoto; Norifumi Kawada; Akio Ido; Daiki Miki; Masayuki Kurosaki; Hitoshi Yoshiji; Ryotaro Sakamori; Hidekatsu Kuroda; Hiroshi Yatsuhashi; Taro Yamashita; Yoichi Hiasa; Naoya Kato; Hisamitsu Miyaaki; Yoshiyuki Ueno; Yoshito Itoh; Kentaro Matsuura; Taro Takami; Yasuhiro Asahina; Goki Suda; Norio Akuta; Ryosuke Tateishi; Yasunari Nakamoto; Eiji Kakazu; Shuji Terai; Masahito Shimizu; Masanori Miyazaki; Yasutoshi Nozaki; Satoshi Sobue; Hiroki Yano; Tomokatsu Miyaki; Akihiro Moriuchi; Takeshi Hori; Kumiko Shirai; Kazuhiro Murai; Yoshinobu Saito; Takahiro Kodama; Tomohide Tatsumi; Tomomi Yamada; Tetsuo Takehara

doi:10.1111/hepr.14131

Factors involved in gastroesophageal varix-related events in patients with hepatitis C virus-related compensated and decompensated cirrhosis after direct-acting antiviral therapy

Hepatol Res. 2024 Oct 29. doi: 10.1111/hepr.14131. Online ahead of print.

Authors

Yuki Tahata¹, Hayato Hikita¹, Satoshi Mochida², Nobuyuki Enomoto³, Norifumi Kawada⁴, Akio Ido⁵, Daiki Miki⁶, Masayuki Kurosaki⁷, Hitoshi Yoshiji⁸, Ryotaro Sakamori¹, Hidekatsu Kuroda⁹, Hiroshi Yatsuhashi¹⁰, Taro Yamashita¹¹, Yoichi Hiasa¹², Naoya Kato¹³, Hisamitsu Miyaaki¹⁴, Yoshiyuki Ueno¹⁵, Yoshito Itoh¹⁶, Kentaro Matsuura¹⁷, Taro Takami¹⁸, Yasuhiro Asahina¹⁹, Goki Suda²⁰, Norio Akuta²¹, Ryosuke Tateishi²², Yasunari Nakamoto²³, Eiji Kakazu²⁴, Shuji Terai²⁵, Masahito Shimizu²⁶, Masanori Miyazaki²⁷, Yasutoshi Nozaki²⁸, Satoshi Sobue²⁹, Hiroki Yano³⁰, Tomokatsu Miyaki³¹, Akihiro Moriuchi³², Takeshi Hori³³, Kumiko Shirai¹, Kazuhiro Murai¹, Yoshinobu Saito¹, Takahiro Kodama¹, Tomohide Tatsumi¹, Tomomi Yamada³⁴, Tetsuo Takehara¹

Affiliations

¹ Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
² Department of Gastroenterology and Hepatology, Saitama Medical University, Saitama, Japan.
³ First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
⁴ Department of Hepatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
⁵ Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medicine and Dental Sciences, Kagoshima, Japan.
⁶ Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
⁷ Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
⁸ Department of Gastroenterology, Nara Medical University, Nara, Japan.
⁹ Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Yahaba, Iwate, Japan.
¹⁰ Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan.
¹¹ Department of Gastroenterology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
¹² Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
¹³ Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.
¹⁴ Department of Gastroenterology and Hepatology, Nagasaki University of Graduate School of Biomedical Sciences, Nagasaki, Japan.
¹⁵ Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan.
¹⁶ Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹⁷ Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
¹⁸ Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
¹⁹ Department of Gastroenterology and Hepatology, Department of Liver Disease Control, Tokyo Medical and Dental University, Tokyo, Japan.
²⁰ Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
²¹ Department of Hepatology, Toranomon Hospital, Tokyo, Japan.
²² Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
²³ Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
²⁴ The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Chiba, Japan.
²⁵ Division of Gastroenterology and Hepatology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan.
²⁶ Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
²⁷ Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan.
²⁸ Department of Gastroenterology, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
²⁹ Department of Gastroenterology, Kasugai Municipal Hospital, Kasugai, Japan.
³⁰ Department of Gastroenterology, Oshima Hospital, Kagoshima, Japan.
³¹ Department of Gastroenterology, Toyokawa City Hospital, Toyokawa, Japan.
³² Department of Gastroenterology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan.
³³ Department of Gastroenterology, Kagoshima City Hospital, Kagoshima, Japan.
³⁴ Department of Medical Innovation, Osaka University Hospital, Suita, Osaka, Japan.

PMID: 39470448
DOI: 10.1111/hepr.14131

Abstract

Aim: The incidence of and factors involved in gastroesophageal varix-related events in hepatitis C virus-related cirrhosis patients, including decompensated cirrhosis, after direct-acting antiviral therapy are unclear.

Methods: We conducted a multicenter study using prospective data from 478 hepatitis C virus-related cirrhosis patients treated with direct-acting antiviral therapy from February 2019 to December 2021 at 33 Japanese hospitals. Gastroesophageal varices were classified as F1 (small-caliber), F2 (moderately enlarged), or F3 (markedly enlarged) according to the Japanese criteria. Patients without varix or with F1 without red color signs were defined as low-risk varix, and patients with ≥F2 or red color signs or a history of rupture were defined as high-risk varix. Varix-related events were defined as prophylactic treatment or rupture of gastroesophageal varix.

Results: The median age was 70 years, 43% of patients had decompensated cirrhosis, and 16% had high-risk varices (13% in compensated and 33% in decompensated, p < 0.001). Sustained virologic response rates were 94.9% for compensated cirrhosis and 91.3% for decompensated cirrhosis (p = 0.120). Across 35.7 months, 25 patients received prophylactic treatment, and four experienced varix rupture. The 3-year incidence rate of varix-related events was 6.2% (3.5% in compensated and 9.9% in decompensated, p = 0.001). In the multivariate analysis, high-risk varix (p < 0.001), high baseline gamma-glutamyl transpeptidase levels (p < 0.001), and virologic failure (p = 0.004) were significantly involved in varix-related events.

Conclusions: The cumulative incidence rate of varix-related events was significantly higher in decompensated cirrhosis than in compensated cirrhosis. Baseline varix status, baseline gamma-glutamyl transpeptidase levels, and virologic response were related to varix-related events after direct-acting antiviral therapy.

Keywords: DAA; HCV; esophagogastric varix; sustained virologic response; varix aggravation; varix rupture.

Abstract

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