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Hepatitis C virus-associated decompensated liver cirrhosis with refractory hepatic encephalopathy successfully treated by balloon-occluded retrograde transvenous obliteration after sofosbuvir/velpatasvir

Clinical Journal of Gastroenterology volume 13, pages 1303–1309 (2020)Cite this article

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.

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Affiliations

  1. Department of Gastroenterology and Hepatology, Kusunoki Hospital, 607-22 Fujioka, Fujioka, Gunma, 375-0024, Japan

    Satoshi Takakusagi, Megumi Shimizu, Yozo Yokoyama, Kazuko Kizawa, Kyoko Marubashi, Takashi Kosone & Hitoshi Takagi

  2. Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Megumi Shimizu, Ken Sato, Satoru Kakizaki & Toshio Uraoka

  3. Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, 370-0829, Japan

    Satoru Kakizaki

Authors
  1. Satoshi Takakusagi
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  2. Megumi Shimizu
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  3. Yozo Yokoyama
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  4. Kazuko Kizawa
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  5. Kyoko Marubashi
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  6. Takashi Kosone
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  7. Ken Sato
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  8. Satoru Kakizaki
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  9. Hitoshi Takagi
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  10. Toshio Uraoka
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Corresponding author

Correspondence to Satoru Kakizaki.

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Conflict of interest

Satoshi Takakusagi, Megumi Shimizu, Yozo Yokoyama, Kazuko Kizawa, Kyoko Marubashi, Takashi Kosone, Ken Sato, Hitoshi Takagi, and Toshio Uraoka declare that they have no conflict of interest. Satoru Kakizaki received lecture fee from Gilead.

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Takakusagi, S., Shimizu, M., Yokoyama, Y. et al. Hepatitis C virus-associated decompensated liver cirrhosis with refractory hepatic encephalopathy successfully treated by balloon-occluded retrograde transvenous obliteration after sofosbuvir/velpatasvir. Clin J Gastroenterol 13, 1303–1309 (2020). https://doi.org/10.1007/s12328-020-01229-x

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  • DOI: https://doi.org/10.1007/s12328-020-01229-x

Keywords

  • Hepatitis C
  • Decompensated cirrhosis
  • Sustained viral response
  • Balloon occluded retrograde transvenous obliteration