The risk of hepatocellular carcinoma (HCC) development is reduced following viral elimination by interferon therapy in chronic hepatitis C patients. However, the risk in patients treated with interferon-free direct-acting antivirals (DAAs) is unknown. We evaluated chronic hepatitis C patients who achieved viral eradication by pegylated-interferon plus ribavirin (PEG-IFN/RBV, n = 244) or daclatasvir plus asunaprevir (DCV/ASV, n = 154) therapy. None of the patients had prior history of HCC or antiviral therapy. The median observation period after the end of treatment for the PEG-IFN/RBV and DCV/ASV groups were 96 (range 10–196) and 23 (range 4–78) months, respectively. During the observation period, HCC developed in 13 (5.3%) and 7 (4.5%) patients in the PEG-IFN/RBV and DCV/ASV groups, respectively. The cumulative HCC development rate after 1-, 3- and 5-years (0.4%, 3% and 5% for the PEG-IFN/RBV group and 0.6%, 9% and 9% for the DAA group, respectively) were similar between the two groups. Propensity score matching analysis also showed no significant difference in HCC development rates between the two groups. Serum AFP levels decreased to similar levels between PEG-IFN/RBV and DCV/ASV groups following the achievement of viral eradication. The risk for HCC development following viral eradication by IFN-free DAA therapy may be similar to that in IFN-based therapy.

Although the effect of levocarnitine (L‐carnitine) on hyperammonemia has been reported in patients with liver cirrhosis (LC), its effect on sarcopenia remains to be elucidated. We assessed the effects of L‐carnitine on sarcopenia in patients with LC. We retrospectively evaluated 52 patients with LC who were treated with L‐carnitine for more than 3 months between February 2013 and June 2017. Computed tomography was used to measure the cross‐sectional area of the skeletal muscles at the level of the third lumbar vertebra. The relative change in skeletal muscle index (SMI) per year (ΔSMI/year) was computed in each patient. We evaluated the relationship between ΔSMI/year and various parameters, such as age, sex, liver functional reserve, and dose of L‐carnitine. The median ΔSMI/year for all patients was −0.22%. The ΔSMI/year values in Child‐Pugh classes A, B, and C were not significantly different among the three groups. There was no significant relationship between ΔSMI/year and sex, age, body mass index, and sarcopenia. Multivariate analysis showed that only a high dose of L‐carnitine (odds ratio [OR], 4.812; 95% confidence interval [CI], 1.233‐18.784; P = 0.024) was associated with increased muscle mass. The L‐carnitine high‐dose group included a significantly larger number of patients with increased muscle mass compared with the low‐dose group (OR, 3.568; 95% CI, 1.138‐11.185; P = 0.027). Administration of L‐carnitine led to a significant and gradual reduction in serum ammonia levels. Conclusion: L‐carnitine seems to suppress the progression of sarcopenia dose dependently, and this was noted to be associated with the improvement of hyperammonemia in patients with LC.

Serum M2BPGi values increased in patients with acute liver injury and decreased following recovery. The marker seems to reflect not only liver fibrosis but also other factors, such as liver inflammation, liver damage, and hepatocyte regeneration.

Background and Aim To examine the effect on recurrence and survival of treatment by interferon (IFN)‐free direct‐acting antivirals (DAA) for patients with hepatitis C virus (HCV)‐associated hepatocellular carcinoma (HCC) who underwent primary curative treatment. Methods This was a retrospective cohort study of 250 patients with HCV who had received curative treatment for primary HCC. As anti‐HCV treatment after HCC treatment, 38 patients received IFN‐free DAA therapy (DAA patients) and 94 received IFN‐based therapy (IFN patients). The recurrence of HCC and overall survival of the patient groups were compared in a case‐control study. Results The cumulative HCC recurrence rates at 1, 3, and 5 years were 5%, 39%, and 39% for DAA patients and 0%, 46%, and 62% for IFN patients, respectively (P = 0.370). Multivariate analysis of the HCC recurrence identified treatment responses (sustained virological response [SVR]: hazard ratio [HR] 2.237; P = 0.003) as an independent predictive factor. The cumulative overall survival rates at 3 and 5 years were 96%, 96% for DAA patients and 93%, 73% for IFN patients, respectively ( P = 0.163). Multivariate analysis identified treatment responses (SVR: HR 8.742; P < 0.001) as independent predictors of overall survival. Propensity score matching analysis showed no significant difference in HCC development rates and overall survival rates in the two groups. Conclusions We found that SVR obtained after curative treatment for primary HCC suppressed recurrence and improved overall survival. And, IFN‐free DAA therapy after curative treatment for primary HCC could predict improving overall survival and suppressed HCC recurrence.