Direct and indirect evidence for the reversibility of cirrhosis.
The aim of this study was to assess the reversibility of cirrhosis after therapy in a large series of patients with cirrhosis from various etiologies. We performed a retrospective study of 113 patients with biopsy-proven cirrhosis who underwent specific therapy and follow-up biopsies. Two pathologists performed blinded analyses of indirect biochemical and morphological signs of cirrhosis. Fourteen (12.4%) of the 113 cirrhotic patients had biopsy-proven disappearance of cirrhosis, defined as a decrease of 2 or greater in their METAVIR fibrosis score: 8 were related to hepatitis C virus, 3 to hepatitis B virus, and 3 to autoimmune cirrhosis. Necro-inflammatory activity decreased from 2.4 +/- 0.65 to 0.85 +/- 0.9 (P = .004), and fibrosis from 4 to 1.7 +/- 0.61 (P = .001). Prothrombin time (n = 1), platelet count (n = 2), serum albumin level (n = 2), and ultrasound abnormalities (n = 6) normalized in patients who had initial abnormalities. Hyaluronic acid and procollagen type III serum level decreased in all. In the 11 patients with regression of viral cirrhosis, 2 were nonresponders and 9 were responders, including 2 relapsers. The 3 patients with regressive autoimmune cirrhosis were complete responders to immunosupressive therapy. Using repeated liver biopsies, clinicobiochemical, radiologic, and endoscopic tests, we provide evidence for potential reversibility of cirrhosis after long-lasting suppression of the necro-inflammatory activity of liver disease.
Serpaggi
Jeanne
J
Service d'Hépatologie et INSERM U-567, Hôpital Necker Enfants-Malades, Paris, France.
Carnot
Françoise
F
Nalpas
Bertrand
B
Canioni
Danièle
D
Guéchot
Jérôme
J
Lebray
Pascal
P
Vallet-Pichard
Anaïs
A
Fontaine
Hélène
H
Bedossa
Pierre
P
Pol
Stanislas
S
D001706:Biopsy; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology / Q000628:therapy*; D008104:Liver Cirrhosis, Alcoholic / Q000628:therapy; D008297:Male; D010446:Peptide Fragments / Q000097:blood; D011347:Procollagen / Q000097:blood; D012189:Retrospective Studies; D016896:Treatment Outcome
D010446:Peptide Fragments; D011347:Procollagen; C041876:procollagen Type III-N-terminal peptide; D006820:Hyaluronic Acid