Shear wave elastography-based liver fibrosis assessment in patients with chronic hepatitis E displays elevated liver stiffness regardless of previous antiviral therapy

Abstract

Background: Hepatitis E virus (HEV) infection especially in immunocompromised individuals can lead to chronic hepatitis. Aggressive courses of chronic hepatitis E leading to liver cirrhosis in a short period of time have been described, but evidence on the degree of liver involvement in chronic hepatitis E is rare. We therefore aimed to quantify liver fibrosis in patients with chronic active hepatitis E compared to patients with sustained virological response after ribavirin (RBV) treatment using 2D-shear wave elastography (2D-SWE) to measure liver stiffness.Methods: Patients with chronic hepatitis E underwent 2D-SWE, B-mode and Doppler ultrasound and laboratory testing in order to assess severity of liver involvement. Results:In this cross-sectional study, we included 14 patients of whom 8 had ongoing chronic hepatitis E and 6 patients had been successfully treated for chronic hepatitis E. The most frequent cause for immunosuppression was prior kidney transplantation (n=12), one patient was a multivisceral transplant recipient, one had been treated for lymphoma. Five patients cleared HEV after RBV therapy, one patient reached viral clearance after reduction of his immunosuppressive medication. Using 2D-SWE measurement, 71.4% displayed increased stiffness indicative of liver fibrosis: 57.1% classified as significant fibrosis and 14.3% as severe fibrosis. Liver stiffness did not differ between patients with active chronic hepatitis E and in patients who had cleared HEV (1.59 and 1.54 m/s respectively). Compared with a control group of kidney transplant recipients without hepatitis E (1.44 m/s), the patients with a history of hepatitis E displayed a significantly higher liver stiffness (P=0.04).Conclusions: In our cohort of chronic hepatitis E patients, elevated liver stiffness indicating liver fibrosis was common and significantly higher than in controls. This is consistent with prior sparse reports of the presence of liver fibrosis or cirrhosis in chronic hepatitis E and emphasizes the need for HEV testing, therapy and research on new therapeutic options. As elevated liver stiffness was also present in patients after HEV treatment, continuous liver surveillance including elastography and ultrasound should be considered.

Risk Factors for Hepatitis E Virus Infection and Eating Habits in Kidney Transplant Recipients

“…From our cohort of 59 KTRs with HEV infection, transient elastography or shear wave elastography measurements were available from 32 KTRs and demonstrated substantial liver stiffness in 15. Since this was a retrospective study, we could not include control KTRs without hepatitis E, but this was shown in a previous study by Schulz et al, where liver stiffness was significantly higher in KTRs with a history of hepatitis E than in control KTRs [ 21 ]. The use of serial measurements for liver surveillance and changes in liver elasticity during HEV disease or after treatment should be investigated in future prospective studies.…”

“…For the liver stiffness measurement, patients underwent either transient elastography (Fibroscan ® , Echosens, Paris, France) or shear wave elastography measurement using a Canon (formerly Toshiba) Aplio 500 US system (Canon Medical systems Corporation, Otawara, Tochigi, Japan). The examination techniques were described elsewhere [ 21 ] and were performed in accordance with guidelines [ 22 ]. Transient elastography and shear wave elastography are both well-established and reliable techniques for assessing liver stiffness [ 23 ].…”

Efficacy of shear wave dispersion imaging for viscoelastic assessment of the liver in acute graft-versus-host disease rats

“…The velocity of shear waves (SW) in tissue increases with increasing tissue stiffness ( 9 ). Previous studies have reported wide use of SWE to assess liver stiffness ( 10 , 11 ). After allo-HSCT, elastography has been demonstrated to improve the accuracy of early diagnosis of hepatobiliary complications ( 12 ).…”