Hepatitis C virus-associated decompensated liver cirrhosis with refractory hepatic encephalopathy successfully treated b
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CASE REPORT
Hepatitis C virus‑associated decompensated liver cirrhosis with refractory hepatic encephalopathy successfully treated by balloon‑occluded retrograde transvenous obliteration after sofosbuvir/velpatasvir Satoshi Takakusagi1 · Megumi Shimizu1,2 · Yozo Yokoyama1 · Kazuko Kizawa1 · Kyoko Marubashi1 · Takashi Kosone1 · Ken Sato2 · Satoru Kakizaki2,3 · Hitoshi Takagi1 · Toshio Uraoka2 Received: 6 August 2020 / Accepted: 30 August 2020 © Japanese Society of Gastroenterology 2020
Abstract Sofosbuvir/velpatasvir (SOF/VEL) is expected to be highly effective, even in patients with decompensated liver cirrhosis. However, portal hypertension can be problematic after achieving a sustained viral response (SVR), especially in patients with hepatic encephalopathy (HE) associated with large portal-systemic shunt. Although balloon-occluded retrograde transvenous obliteration (BRTO) is a useful option, whether BRTO or SOF/VEL therapy should be initially performed in patients with a poor liver function reserve is controversial. We herein report a case of refractory HE caused by decompensated liver cirrhosis due to hepatitis C virus (HCV) classified as Child–Pugh class C that was treated by BRTO after SVR with SOF/VEL. A 64-year-old woman with HCV-associated decompensated cirrhosis developed refractory HE. Dynamic contrast-enhanced computed tomography (CT) revealed large portal-systemic shunt. We treated the patient with 12 weeks of SOF/VEL, and she achieved SVR. Although the serum albumin level, edema, and ascites were improved, intractable HE remained. Her general condition had been improved after SVR, so HE was suspected to have been caused by portal-systemic shunting. We, therefore, treated the patient by BRTO. On dynamic contrast-enhanced CT, partial obstruction of the shunt vessel was confirmed after BRTO. Thereafter, her serum ammonia level rapidly improved, and HE did not recur. Interventional radiology such as BRTO following SOF/VEL therapy may be a useful option even in patients with decompensated HCV-associated cirrhosis accompanied by portal-systemic shunt. Keywords Hepatitis C · Decompensated cirrhosis · Sustained viral response · Balloon occluded retrograde transvenous obliteration
Introduction
* Satoru Kakizaki kakizaki@gunma‑u.ac.jp Satoshi Takakusagi [email protected] 1
Department of Gastroenterology and Hepatology, Kusunoki Hospital, 607‑22 Fujioka, Fujioka, Gunma 375‑0024, Japan
2
Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3‑39‑15 Showa‑machi, Maebashi, Gunma 371‑8511, Japan
3
Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma 370‑0829, Japan
Direct-acting antivirals (DAAs) have become the first choice of treatment for chronic hepatitis C (CHC) worldwide. The introduction of sofosbuvir/velpatasvir (SOF/ VEL) is expected to be highly effective, even in patients with decompensated cirrhosis [1]. Furthermore, the combination therapy of SOF/VEL and ribavirin was repo
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