Hep C Discussion Forum

dustbear · Senior Member

RE: Liver Regeneration?

Tig · Admin

Excellent topic and discussion everyone! Very informative!

mallani · Guru

Hi dustbear,

Yes there is an F0. It means a normal liver or very minimal fibrosis. A0 means there is no periportal inflammation, or just a few lymphocytes at worst. the A refers to Inflammation (or activity).

Fibroscan measures liver stiffness using an Ultrasound beam. It takes about 10 minutes to get the 12 readings, and is non-invasive. The Europeans love it, but it is most accurate in F0, F0-1, F1, F3-4 and F4 patients. It is now approved in the USA, but Hepatologists will take some convincing. It over-reads fibrosis stage in fatty livers, although a new probe has been developed to counter this, and Echosens claim this can actually measure the amount of fatty infiltration. I'm looking forward to asking my doc about this next week, as he had the first Fibroscan machine in Australia, in 2008, and has extensive experience comparing Fibroscan readings with biopsies. Don't rush into another biopsy after SVR. It takes time for liver regeneration and fibrosis absorption to appear. I'd wait at least a year.

Zlikster buddy: In some post SVR patients, the fibrosis has a mind of it's own, and cytokines continue to be released with stimulation of fibroblasts to lay down even more fibrous tissue. It is thought that the existing fibrosis continues to damage hepatocytes with subsequent cytokine release. If you look up liver regeneration after SVR, there are studies that give fibrosis progression rates after SVR, of between 2 and 10 %. I'm going to ignore them. Cheers.

dustbear · Senior Member

Hi Mallani: I will have to chat with my hepa again. My liver is at F2 from a biopsy I got. I definitely want a biopsy after achieving SVR! So, I guess I'll back up to an F0-1.

Hi Zlikster: That was my next question, is there an F0? Don't know what the A0 means, tho. I just read about the FibroScan recently and wonder how it differs from a biopsy, or is that a type of machine that does the same thing?

Zlikster · Guru

i am also keen to see how fast and can i get back to F0/A0 (from F0-1 A1 and a bit fatty liver) but without biopsy...just FibroSure , FibroScan and ultrasound will hopefully let me know. I am optimistic.

How SVR can lead to worsening of fibrosis?

mallani · Guru

Hi Dustbear,

This is still controversial. Different studies have given conflicting reports. Most agree that SVR will result in reduced liver inflammation (down to A0) and the general consensus is that most patients will achieve a degree of fibrosis reversal. This takes time (up to 10 years), but about 50% of patients with SVR can reverse their fibrotic stage by 1 or 2 stages ( eg an F3 could become an F1, and a F2 could become a F0-1). One study showed 20% of cirrhotics (F4) reverted to F3. Obviously this sort of study is limited as patients are unwilling to have repeated liver biopsies, particularly if they achieve SVR. Fibroscan followup will be interesting. It all depends on the thickness of the fibrotic bands in F3's and F4's. The deactivation of the stellate cells ( that produce fibrosis), collagen-absorbing enzymes and activation of stem cells (sinusoidal lining cells) all play a part. To 'grow back as good as new' is a bit optimistic, but some improvement should be noted in most patients. Unfortunately, in some patients (up to 10%), SVR has led to a worsening of fibrosis.

Obviously the risk of HCC remains, but is markedly reduced. Most Hepatologists would agree that 6 monthly screening is still required after SVR for cirrhotics, and probably for F3's and F3-4's.

dustbear · Senior Member

I asked myself this question today.

I recall my doctor saying you can lose up to 90% of the liver, except for cirrhosis, and it will grow back as good as new.

I asked my hepatologist how long and he said it will grow back within 6-12 months after EOT.

You would think that it would start to grow back after being UND.

Deidre · Senior Member

Interesting. I have 3 bulging discs in neck pinching two nerves wich have caused arm damage, need surgery, but no insurance so can't get, now neck points the opposite way.. I also have low back problems. They say for some reason the hep attacked mt joints discinergrating them, So I have degenrative disc, degenerative jionts. It even caused my rotorary cuff to get to thin and tare without injury. Because of this they ave kept me on very strong pain meds and muscle relaxers, 4x a day since 96. In the last couple years they are so strong, they have me on as strong of pain killer as when I had a hysterectomy. Morphine doesn't work on me or my mom for that matter, and I'm in the 6 % that versid doen't either. I take a morphine substitute dilaudid, it's like a cousin of morphine, but the compound is different. So I wonder if I'll feel better.

jan · Senior Member

Deidre I had spasmodic, intense lower back pain. Knee pain and shooting pains in my head. (very worrying) I had pins and needles in my hands, mainly at night. The pain was starting to become more frequent and more debilitating. Thank God its gone. x

Cinnamon Girl · Guru

Hi there Olddude from an even older gal! smile

As people have said, the liver can regenerate after tx except where cirrhosis has occured. Yes, the fact that you stopped drinking once you got the diagnosis will have made a difference I`m sure and will have prevented more damage, so well done for that.

I finished tx last March, and like Jan, have more energy than I`ve had for years, having been quite disabled with fatigue and other symptoms for many years before I did tx. My liver enzymes have gone back to normal since tx, which means that the inflammation has gone.

All the best of luck to you this time round, onwards to SVR!

Jill xx

ps - Oh, and congrats on being UND at 4 weeks!

-- Edited by Cinnamon Girl on Thursday 26th of January 2012 07:43:40 PM

Deidre · Senior Member

Jan did you have much pain vefore you started treatment?

jan · Senior Member

Hi, my specialist told me my liver would return to normal after successful tx. I had moderate liver damage. I am now 18 months post tx and have never felt better. Eventualy all my aches have gone and I have more energy than I can remember having in a long time. I hope this is an encouragement to you all. Tx is tough but so worth it.

Jan x

Deidre · Senior Member

In 2002 before I did treatment the first time my liver biopsy was at a 3. After being clear for 4 months the hep c relapsed. However I did have another biopsy in both 07, and right before I started treatment this time, and they were both a two. So yeas I believe when the liver has some time where it's not being attacked constantly it does start to heal.

Unless it's chirosis

LanaiSurferGirl · Senior Member

I have not done research on it but my doctor did tell me that if we get rid of the hep c that the liver can regenerate! :)

Hep Me · Senior Member

Hi OldDude,
I've heard the liver is the most resilient of all organs. I was told over half of it can be cut out and it will grow back in like six months or so. I don't recall where I got that from but you can probably google it. But I'm curious to know too how well it repairs itself after hep-c. I haven't drank either for a lot of years, but my drug clean time is not quite five years - so I'm sure my ol' liver gave me some brownie points as well as took a few back away. I know scarring and cirrhosis plays a role too.

Anyone out there know off hand?

Randy

OLDDUDE · Member

Has anyone done any research on how the liver repairs itself, or if it does, when the Hep-C virus is cleared? I've heard that the liver is capable of regenerating itself, healing itself, etc. but I'm curious if this is the same for Hep-C patients. No alcohol or drugs except those prescribed by my doctor since I was first diagnosed over 15 years ago. Does that make a difference? I have a good chance of SVR this time and I'm wondering if my liver will ever be able to do it's job so I can feel human again.

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