Is Cirrhosis Reversible?
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Is Cirrhosis Reversible?
Abstract 1015. AASLD, Nov 2001. REVERSIBILITY OF
At AASLD, there were 2 additional reports showing
treatment can improve fibrosis.
1. investigators report finding improved fibrosis
progression following HCV therapy in patients with
advanced liver disease (stage 3/4). For nonresponders,
fibrosis progression reversed, and for nonresponders
2. Poynard & French research group report 49% with
cirrhosis showed some degree of reversal of cirrhosis
from F4 stage to either F3, F2 or F1; achieving a
sustained response was a significant factor.
Non-responders can slow fibrosis.
3. Jenny Heathcote reported from study of cirrhotics
receiving Pegasys that patients with cirrhosis could
improve their histology (a histologic response in this
study was defined as a decrease of at least 2 points
on the 22-point Histological Activity Index). 30%
using Pegasys montherapy achieved a sustained response
vs 8% using standard interferon.
Jeanne Serpaggi, Francoise Carnot, Bertrand Nalpas,
Ana�s Vallet Pichard, J�rome Guechot, Jean Luc
Lagneau, Christian Brechot, Stanislas Pol, Necker
Hosp, Paris France
Aim: To revisit the concept of the irreversibility of
cirrhosis by analyzing a large series of non
immunocompromised patients with cirrhosis of various
etiologies. Methods: Retrospective analysis of the 113
cirrhotic patients who had biopsy proven cirrhosis,
then specific therapy and follow-up biopsies.
Resolution of cirrhosis was defined as a decrease of
the fibrosis score 32 by Metavir score after blinded
analysis by the same pathologist. The biochemical
(platelets, prothrombin time, hyaluronate and
PIIINP)and morphological US markers of cirrhosis were
also analyzed. Results: Respective etiologies of
cirrhosis were the following : HCV (68%), HBV (15%),
alcohol (8%), auto-immune (9%). Forteen (all
Child-Pugh A stage) of the 115 cirrhotic patients
(12%) had biopsy-proven disappearance of cirrhosis
with a median time between the two biopsies of 4.3 �
2.1 years. Eight had virus HCV-related cirrhosis
including 1 with heavy drinking, 3 HBV including 1
with heavy drinking, and 3 auto-immune cirrhosis. In
these 14, by the Metavir score, activity decreased
from 2.4 � 0.65 to 0.85 � 0.9 (p=0.004) and fibrosis
from 4 to 1.7 � 0.61 (p=0.001). Normalisation of the
prothrombine time (n=1), of the platelet count (n=2),
of serum albumin level (n=2), of ultrasound
abnormalities (n=6) were observed in the 11 patients
who had initial features of portal hypertension or
hepatic insufficiency. Following therapy, serum
markers (hyaluronate, PIIINP) of fibrosis decreased in
all patients but more significantly in those pts with
cirrhosis reversibility (- 95 vs. - 17 mg/l and - 0.58
vs. - 0.17 U/l, respectively). Among the 11 regressive
patients with viral cirrhosis, 7 were sustained
responders and 2 relapsers to anti-viral therapy and
they accounted for 23 % of the responders. All
patients with autoimmune cirrhosis responded to
immunosuppressive therapy (steroid and azathioprine)
and accounted for 30 % of the responders.
Conclusions: With repeated liver biopsies,
clinico-biochemical, radiological and endoscopy tests,
we provide strong evidence for potential reversibility
of cirrhosis. Thus, long lasting decrease or
suppression of the necrotico-inflammatory activity of
liver disease allowed complete regression of extensive
fibrosis or cirrhosis.
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