1School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Australia.
BACKGROUND AND AIM:
Rates of long term clinical outcomes of chronic hepatitis C in patients with none, mild or severe liver fibrosis are required to determine benefits of anti-viral therapies. This study evaluated long term outcomes for chronic hepatitis C stratified by all Metavir fibrosis stages.
Clinical outcomes were determined using population based data-linkage methodology for 880 hepatitis C patients who had a liver biopsy performed from 1992 to 2012.
During 9386 person-years of follow-up, 28 patients developed hepatocellular carcinoma, 58 developed liver decompensation and 122 died or underwent liver transplantation. There was no significant difference in liver related death for those with F0-F2 with an 18 year survival probability > 94%. Hazard ratio of liver related death for F3 compared to F0-F2 was 4.24 (P=0.003), with no significant difference in the first 13 year follow up. The 15 year decompensation free survival for F0, F1 and F2 was 100%, 96% and 94% respectively and for hepatocellular carcinoma free survival was 100%, 99% and 98%. Hazard ratio of liver complication (hepatocellular carcinoma or decompensation) free survival for F3 compared to F0-F2 was 3.22 (P=0.001), with no significant difference during the first seven year follow up. F4 had significantly higher risk of liver related death, decompensation and hepatocellular carcinoma than F3 (p<0.001).
Chronic hepatitis C patients with F2 or less had few liver complications after 15 years. For F3 patients the significant increase in liver related death occurred after 13 years and for liver complications after seven years.