Is cirrhosis reversible

DR N MURUGAN,MRCPI, FRCP G, Fellow Hepatology,

Hepatologist & Liver Transplant Physician,Apollo Hospitals Chennai.

YES and NO

2014 Robbins….although uncommon regression of fibrosis does occur .. ..we now understand that regression of scars can take

place .. All cirrhotic livers show elements of progression and regression, the balance determined by the severity

and persistence of the underlying disease.

Histological-hemodynamic correlation

in cirrhosis

• S. Nagula, D. Jain, R.J. Groszmann, G. Garcia-Tsao. Histological-hemodynamic correlation in cirrhosis-a histological classification of the severity of cirrhosis. J Hepatol, 44 (2006), pp. 111–117

• M. Kumar, P. Sakhuja, A. Kumar, N. Manglik, A. Choudhury, S. Hissar, S K Sarin. Histological subclassification of cirrhosis based on histological-haemodynamic correlation. Aliment Pharmacol Ther, 27 (2008), pp. 771–779

• S. Sethasine, D. Jain, R.J. Groszmann, G. Garcia-Tsa. Quantitative histological-hemodynamic correlations in cirrhosis. Hepatology, 55 (2012), pp. 1146–1153

• AASLD/NIH position paper

• Hepatology. 2010 Apr; 51(4): 1445–1449.

• Now There Are Many (Stages) Where Before There Was One: In Search of a Pathophysiological Classification of Cirrhosis

• Guadalupe Garcia-Tsao (Yale University), Scott Friedman (Mount Sinai, New York), John Iredale (university of Edinburgh), and Massimo Pinzani (University of Firenze, Italy).

• We encourage the practicing community, pathologists, and investigators to move beyond the simple characterization of cirrhosis as a single stage and instead begin thinking of cirrhosis as a series of critical steps that, if left unchecked, culminate in hepatic decompensation.

• A new framework for classifying cirrhosis will require integration of both current and emerging knowledge about liver structure and function

• From one stage, there should emerge many.

assessment of cirrhosis stage - clinical severity

• HVPG correlates well with increasing severity of liver disease. Fibrosis stages 3 or 4 have an HVPG of ≥ 6 mmHg; HVPG > 10 mmHg defines the presence of “clinically significant portal hypertension”

• Simple histologic features - thickness of fibrous septa correlates with HVPG; predictor of clinically significant portal hypertension

• Liver stiffness measurement (LSM) obtained by transient elastography - excellent correlation with HVPG values up to 10–12 mmHg need to be further substantiated

Long term changes in liver histology following treatment of chronic hepatitis C virus

Mitchell L. Shiffman,* Richard K. Sterling,** Melissa Contos,*** Sarah Hubbard,** April Long,* Velimir A. Luketic,** R. Todd Stravitz,** Michael Fuchs,** Arun J. Sanyal**

Annals of Hepatology 2013

Regression of fibrosis• All these studies show reversal of fibrosis in cirrhosis

• BUT - Reversal in early cirrhosis (diagnosed on histology) but not in clinical cirrhosis - definitely not in decompensated cirrhosis - No reversal of vascular changes

• Reversal of histological cirrhosis but not clinical cirrhosis

• “Point of no return” in cirrhosis

Thank you