Liver improvement after treatment?

[koifish54]

Just curious how much survivors liver 's are improving after svr can't find too much information out there so I figured this might be a good start to find out I myself feel great but haven't had any scan or bloodwork it's a year since last tests due soon though

[gnatcatcher]

Koi, my FibroScan result went from F4 19.5 kPa before treatment to F3 11.4 kPa nine months after the end of treatment. Some people on these HEP Forums have had more dramatic drops; I hope they'll see your post and reply.

Gnatty

[Lynn K]

Alimentary Pharmacology & Therapeutics Review Article: The Reversibility of Cirrhosis

A. A. Sohrabpour; M. Mohamadnejad; R. Malekzadeh
Aliment Pharmacol Ther. 2012;36(9):824-832.

Abstract and Introduction
Abstract

Background Cirrhosis is the end result of many types of chronic liver diseases. Recent developments in the understanding of the process of hepatic fibrogenesis have revealed that the process is a dynamic one and a capacity for recovery from any degree of fibrosis including those associated with cirrhosis is plausible.
Aim To review current evidence of histopathological reversibility following drug therapy of more common aetiologies of cirrhosis.

Methods
A PubMed search was performed and the evidence for histopathological regression of advanced fibrosis/cirrhosis following drug therapy was reviewed as of the end of February 2012.

Results
There is abundant clinical evidence in support of the idea of the reversibility of cirrhosis in patients with different aetiologies of advanced hepatic disease including viral, autoimmune and metabolic/infiltrative liver disease.

Conclusions The concept of cirrhosis has changed from being a form of static and irreversible entity to a dynamic and reversible diseases stage. Novel therapeutic strategies are under investigation to target specific steps in the process of fibrogenesis with the aim of reversing advanced fibrosis/cirrhosis.

Cirrhosis, also know as "stage 4 liver disease", can be classified into sub-stages. The chance for reversibility of cirrhosis declines as the liver goes through more advanced substages of cirrhosis.

"Compensated cirrhosis"
May have no complications or symptoms at all. Blood tests may be normal, but there is usually a low platelet count (12 mmHg portal hypertension.

If you have cirrhosis see a hepatologist who is a liver specialist to learn more about managing your liver disease before it becomes irreversible.

[Lynn K]

So even if you have cirrhosis there is hope of regression of liver disease. For those with F2 or less per the AASLD those patients may be followed as those who never had he c.

Basically the more advanced the liver damage the less odds of regression. While a couple of folks here have has regression when they had been diagnosed as F4 so far for me not much improvement but my platelet count has risen from around 80 to 90  range before treatment to at one year post to around 110 still low but improving

[Jazz]

"Compensated cirrhosis"
May have no complications or symptoms at all. Blood tests may be normal, but there is usually a low platelet count (12 mmHg portal hypertension.

Lynn, am I understanding this correctly - is a low platelet count an indication of portal hypertension?

[Lynn K]

Yes it can be.

My lab uses a scale where 150 is min normal. Mine has been as low as 80 something some folks have gotten as low as the 50's or even 30's at that point the doctors may give transfusions or I guess other methods if available to increase platelet levels.

The liver being heavily scarred from cirrhosis results in an increase in pressure in the primary vein that flows through the liver the portal vein. This increase portal pressure causes the spleen to enlarge and begin to sequester platelets which is why platelet levels begin to decrease.

Also portal hypertension can cause an increase in blood pressure in the next nearest blood system the veins in the esophagus causing those veins to enlarge known as esophageal varicies which I have had. I had grade 3 varicies that needed to be banded.

[Jazz]

Thanks for your reply Lynn. Before my successful Tx, my platelets were always borderline low - my labs lowest normal parameter is 140 and my measure was often hovering around that mark. Post Tx my results have improved - I even scored 185 at one draw!

Why I asked is because my liver health status has not been definitely ascertained. My post Tx Fibroscan measure is 4.8 (pre-Tx 7.6), while my post Tx (and pre-Tx) ultrasound scan images nodules consistent with cirrhosis. My post Tx bloods are all within normal range, yet my pre-Tx ALT, AST were usually 2-3 times higher than normal range, and platelets, as above. My hepatologist can't give me a definitive answer and would like me to undergo an MRI with contrast, but I don't care for the contrast. As you are a moderator, have you come across a similar situation as mine?

[Lynn K]

Ok the fibroscan is just not that accurate in the mid damage ranges for one thing. From what I am seeing on the fibroscan scorecard 7.6 looks like border line F1 to F1/F2 range for patients whose cause of liver damage is hepatitis c and 4.8 is F1

https://upload.wikimedia.org/wikipedia/commons/d/de/FibroScan_Scoring_Card_for_Liver_Stiffness_Diagnosis.png

The gold standard for ascertaining liver damage is the liver biopsy while also imperfect it is more accurate than any other test I am aware of.

However that being said the current recommendations from the AASLD for patients with minimal liver damage (less than F2) is to just go back to living as one who never had hepatitis c no additional follow up would be needed.

It is great to see your platelets are increasing but there are many causes of low platelet count other than liver cirrhosis which apparently you do not have. really liver cirrhosis needs to be at least a little bit advanced beyond the early beginning of cirrhosis.

http://www.mayoclinic.org/diseases-conditions/thrombocytopenia/basics/causes/con-20027170

Just for reference my fibroscan score before treatment was 27 and one year post was 33 but given the relative accuracy of a fibroscan and that it is operator dependent for testing results my thinking is that 27 and 33 is basically no change and your change from 7.6 to 4.8 likely does not mean much.

Anyway in my situation I may have liver improvement or I may not I don't dwell on it much especially as there is not much I can do about it. And anyway I am fine now and I won't get any worse unless I get liver cancer (knock on wood) so I expect to live a normal live span.

I would just follow your doctors recommendations if you want to get to the bottom of this and find out where you stand. Personally I have never had an MRI I had 4 liver biopsies over the years so if you would prefer you could have a biopsy instead if your doctor agrees if you want to avoid the contrast.

The only thing you have said that does cause me some concern it the ultrasound comments "nodules consistent with cirrhosis." which in light of your other testing does not really make a lot of sense. But again ultrasound is not really a good way to diagnosis cirrhosis but more to monitor a liver with known cirrhosis mostly to check flow through the portal vein and look for possible liver tumors.

Anyway I suggest you work with your doctor to find out what is going on. Anything else is total guessing at this point.

[Jazz]

Thanks for your reply Lynn. I just wondered if there were others out there who have had such different diagnoses with said diagnostic equipment.

My liver specialist led me to believe that Fibroscans were a reliable diagnostic, as he said in his experience Fibroscan results matched with the biopsies he had performed. So I was content with that, even though I had read about the unreliability of middle range fibroScan results. I also am aware of the unreliability of UScans too!

So, I look forward to the more accurate, zero invasive MRI scans to be approved and available in my neck of the woods, as i don't want to have a biopsy or contrast dye injected in me just to have a definitive diagnosis of cirrhosis or no - if I have cirrhosis, my body is compensating well. The main thing is not to have HCC and I believe ultrasounds can pick that up.

Btw, my US report has 'echo texture coarsened [and] mild surface nodularity'. The rest of the findings is normal.

[Lynn K]

Really from what you have said I don't think you have cirrhosis. We are so much better off now being cured we won't get worse we may get better and those with less damage have a much better chance of going back to a normal liver.

Good luck

[Jazz]

Thank you Lynn. Good luck to you too. I hope your health continues to thrive now that you're free of hep c

[gnatcatcher]

Jazz, FWIW, my very experienced hepatologist, like your liver specialist, puts a lot of faith in FibroScan scores, even though I was the highly atypical person who had a lower pre-treatment score (F2) on a FibroSure than I had on a FibroScan (F4) taken just two days earlier.

Despite my drop in FibroScan scores changing F4 to F3 and my reaching SVR50, my most recent ultrasound, for the first time, supposedly showed "Mildly coarsened, heterogenous liver consistent with history of hepatitis and cirrhosis" instead of "Normal echogenicity and echotexture." My hepatologist's CNP (who has a doctorate and teaches at the med. school) chalked it up to a different radiologist who had read my diagnosis first. Perhaps my upcoming mid-November US and/or late-December FibroScan will settle the question of whether I do or don't actually have cirrhosis.

I agree with Lynn's conclusion, so have a wonderful life!

Gnatty

[Jazz]

Thanks for your input Gnatty. Whether my liver is cirrohtic or not is not going to interfere with my enjoyment of this wonderful world. I live in a beautiful part of this globe, each day greeted with mother nature's wonders, forever keeping me thankful, despite the occasional reminder that I have a body verging on vintage!