title: Reversibility of hepatic fibrosis in treated genetic hemochromatosis: a study of 36 cases.
abstract: The current study was undertaken to assess whether fibrosis could regress under venesection therapy in patients with C282Y homozygous genetic hemochromatosis. The 36 patients studied were recruited from a subfile of our database consisting of 125 C282Y homozygotes with either severe fibrosis or cirrhosis (F3 or F4 fibrosis stage, respectively, according to the METAVIR grading system). The second liver biopsy was performed for management of liver cancer, extrahepatic surgery, or assessment of liver fibrosis. All paired biopsies were reviewed by two pathologists without knowledge of clinical data. Among the 13 patients who had F3 fibrosis on their initial liver biopsy, 3 had F0, 6 had F1, and 2 had F2 on their second liver biopsy. Among the 23 patients with cirrhosis on their initial liver biopsy, 1 had F0, 4 had F1, 3 had F2, and 2 had F3 on their second liver biopsy. When defining regression of fibrosis as a decrease of at least 2 METAVIR units, fibrosis regressed in 9 of 13 (69%) F3 and in 8 of 23 (35%) F4. When the ratio of gammaglobulins (g/L) to (platelets [n/mm(3)] x prothrombin activity [%]) was greater than 7.5, fibrosis never regressed. In conclusion, these data extend the concept of regression of fibrosis to patients with treated genetic hemochromatosis and suggest that some simple biochemical tests would be predictive of further regression of fibrosis as a result of venesection therapy. If confirmed on larger series, this could modify the ultrasound screening policy of hepatocellular carcinoma in genetic hemochromatosis.
authors.affiliation: Service des Maladies du Foie, CHU Pontchaillou, Rennes, France. ludivine.falize@chu-rennes.fr
authors.forename: Ludivine
authors.initials: L
authors.lastname: Falize
authors.forename: Anne
authors.initials: A
authors.lastname: Guillygomarc'h
authors.forename: Michele
authors.initials: M
authors.lastname: Perrin
authors.forename: Fabrice
authors.initials: F
authors.lastname: Lainé
authors.forename: Dominique
authors.initials: D
authors.lastname: Guyader
authors.forename: Pierre
authors.initials: P
authors.lastname: Brissot
authors.forename: Bruno
authors.initials: B
authors.lastname: Turlin
authors.forename: Yves
authors.initials: Y
authors.lastname: Deugnier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D018450:Disease Progression; D005500:Follow-Up Studies; D006432:Hemochromatosis / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology*; D008875:Middle Aged; D018962:Phlebotomy; D016896:Treatment Outcome