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. 2022 Jul;12(7):3528-3538.
doi: 10.21037/qims-21-1178.

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

Marten Schulz  1 , Mira Choi  2 , Friederike Bachmann  2 , Nadine Koch  2 , Theresa Maria Holtmann  1 , Raphael Mohr  1 , Frank Tacke  1 , Alexander Wree  1
Affiliations

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

Marten Schulz et al. Quant Imaging Med Surg. 2022 Jul.

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.

Keywords: Hepatitis E virus (HEV); liver fibrosis; liver stiffness measurement (LSM); ribavirin (RBV); shear wave elastography (SWE).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-21-1178/coif). FT reports that the laboratory of FT has received funding from Allergan, BMS, Inventiva and Gilead. FT has received honoraria or consulting fees from Allergan, Alnylam, Bayer, Gilead, BMS, Boehringer, Intercept, Ionis, Inventiva, Merz, Pfizer, NGM, CSL Behring, Novo Nordisk, Novartis, Falk. The consulting activities are unrelated to the current study. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
SWE in a patient with chronic hepatitis E. SWE in a 29-year-old male with chronic hepatitis E after kidney transplantation. On the right, propagation of shear waves is depicted by parallel lines; on the left, a color-coded elastogram is displayed in real-time. Liver stiffness was 4.7 kPa. SWE, shear wave elastography.
Figure 2
Figure 2
Comparison of untreated versus successfully treated patients with chronic hepatitis E. Comparison of SWE results in m/s (A) and kPa (B) in treated and untreated patients with chronic hepatitis E. (C-E): comparison of ALT (C), GGT (D) and thrombocytes (E) in treated and untreated patients with chronic hepatitis E. P value in (D) =0.02, all other P values >0.05. SWE, shear wave elastography; ALT, alanine aminotransaminase; GGT, gamma-glutamyl transpeptidase.
Figure 3
Figure 3
Comparison of hepatitis E patients versus control group. Comparison of SWE results in m/s (A) and kPa (B) in patients with a history of chronic hepatitis E versus controls without hepatitis E. P value in (A) and (B) is 0.04. SWE, shear wave elastography.
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