Elastography is unable to exclude cirrhosis after sustained virological response in HCV‐infected patients with advanced chronic liver disease

Background Liver fibrosis and transient elastography (TE) correlation in hepatitis C virus (HCV)‐infected patients with compensated advanced chronic liver disease (cACLD) after the sustained virological response (SVR) is unknown. Aims To evaluate TE accuracy at identifying cirrhosis 3 years after HCV‐eradication. Methods Prospective, multi‐centric study including HCV‐cACLD patients before direct‐acting antivirals (DAA). Diagnostic accuracy of TE (area under ROC, AUROC) to identify cirrhosis 3 years after SVR was evaluated. Results Among 746 HCV‐infected patients (95.4% with TE ≥10 kPa), 76 (10.2%) underwent a liver biopsy 3 years after SVR. Before treatment, 46 (63%) showed a TE>15 kPa. The TE before DAA was the best variable for predicting cirrhosis (METAVIR, F4) after SVR (AUROC = 0.79). Liver function parameters, serological non‐invasive tests (APRI and FIB‐4), and TE values improved after SVR. However, liver biopsy 3 years after HCV elimination (median time = 38.4 months) showed cirrhosis in 41 (53.9%). Multivariate analysis (OR (95% CI), P) showed that HCV‐genotype 3 (20.81 (2.12‐201.47), .009), and TE before treatment (1.21 (1.09‐1.34),