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Liver Volume as a Predictor of Functional Improvement Post-DAA Treatment

Di Maira, Tommaso MD1; Torregrosa, Asunción MD2; Navarro, Vicente MD2; Sánchez, Daniel MD2; Fornés, Victoria MSc3; Berenguer, Marina MD, PhD1,4

doi: 10.1097/TP.0000000000001990
Original Clinical Science—Liver

Background New direct antiviral agents (DAA) for hepatitis C virus treatment result in sustained virologic response (SVR) in most patients. However, predicting the point of no return is still an unmet need for those with advanced liver disease. The aim is to assess if baseline liver volume is a predictor of post-SVR liver function.

Methods Cirrhotic patients assessed for liver transplantation and consecutively treated with DAA between September 2014 and 2015 who achieved an SVR were included. Pretreatment liver volume (LV) and spleen volume (SV) adjusted by body surface area (BSA) were calculated from computed tomography/magnetic resonance images. Liver function was assessed by Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores, and a multivariable mixed regression model was used to identify baseline factors associated with improvement of liver function overtime.

Results We included 42 patients with a median age of 58.6 years (first quartile to third quartile, 52.7-68.8); MELD, 14 (11-17); CTP, 9 (8-10); LV, 1400.9 mL (1183.2-1601.4); SV, 782.9 mL (490.6-1118.8). MELD scores at baseline and at last control were 14 (11-17) and 10 (8-12), respectively (P < 0.001); CTP scores were 9 (8-10) and 6 (5-7), respectively (P < 0.001). In the multivariable model, higher LV/BSA was associated with an improvement of MELD and CTP over time (P = 0.03 and P = 0.044, respectively).

Conclusions LV is a noninvasive tool that can predict functional improvement in cirrhotic patients undergoing DAA therapies.

The authors present data indicating that baseline liver volume can be used to predict functional response of HCV treatment with DAA in liver transplant candidates. Supplemental digital content is available in the text.

1 Liver Transplantation and Hepatology Unit, La Fe University Hospital, Valencia, Spain.

2 Radiology, Abdominal Organs Department, La Fe University Hospital, Valencia, Spain.

3 Biostatistics Unit, Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain.

4 Ciberehd (Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas), Madrid, Spain.

Received 30 May 2017. Revision received 30 August 2017.

Accepted 24 September 2017.

T.D.M. was financed by Rio Hortega research grant 15/00133, supported by Instituto de Salud Carlos III. Ciberehd is partially funded by the Instituto de Salud Carlos III.

The authors declare no conflicts of interest.

Correspondence: Tommaso Di Maira, MD, Avenida Fernando Abril Martorell, 106 (Torre F5), 46026 Valencia, Spain. (

All authors have made substantial contribution to the article. T.D.M. and M.B. designed the research study. T.D.M. collected data, performed the research, analyzed, and interpreted the data, wrote and submitted the article. M.B. wrote and reviewed the article and mentored all phases of the study. A.T., V.N., and D.S. performed CT and RM imaging volumetry, collected the data and reviewed the article. V.F. performed the statistical analysis and reviewed the article.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

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