{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:31:59Z","timestamp":1790627519153,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T00:00:00Z","timestamp":1666742400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Atezolizumab\u2013bevacizumab is the new standard for advanced hepatocellular carcinoma (HCC) but its impact on portal hypertension (PHT) is unknown. We aimed to identify predictive factors of acute variceal bleeding (AVB) and to monitor PHT parameters under treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a prospective study including all cirrhotic patients treated with atezolizumab\u2013bevacizumab since 2020. We performed monitoring of PHT using upper endoscopy at inclusion and at 6\u00a0months and hepatic venous pressure gradient (HVPG) at inclusion, 3 and 6\u00a0months after the beginning of treatment. We also included a retrospective series of patients treated with sorafenib. Time\u2010to\u2010events data were estimated by Kaplan\u2013Meier with the log\u2010rank test, along with Cox models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010three patients treated with atezolizumab\u2013bevacizumab were included (male 79.1%, Child\u2010Pugh A 86%). At baseline, 48.8% were treated with curative anticoagulation, 16.3% already experienced AVB and 25.6% had large oesophageal varices (EV). Sorafenib group characteristics were similar. Vascular invasion was present in 60.5% and median was HVPG 8.5\u2009mm Hg. No significant modification in HVPG and EV size was observed at 6\u00a0months in the whole cohort but also when considering vascular invasion and radiological response. 14% presented AVB within a median time of occurrence of 3\u00a0months, without bleeding\u2010related death. In multivariate analysis, history of AVB (HR\u00a0=\u00a010.58, <jats:italic>p<\/jats:italic>\u00a0=\u2009.03) was associated with AVB. AVB incidence was higher in atezolizumab\u2013bevacizumab compared to sorafenib group (21% vs. 5% at 1 year, <jats:italic>p<\/jats:italic>\u00a0=\u2009.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Atezolizumab\u2013bevacizumab treatment was associated with a higher risk of AVB compared to sorafenib. A history of AVB was associated with AVB during follow\u2010up, which questions the use of bevacizumab in this setting.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15458","type":"journal-article","created":{"date-parts":[[2022,10,18]],"date-time":"2022-10-18T08:09:45Z","timestamp":1666080585000},"page":"2843-2854","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["A history of variceal bleeding is associated with further\u00a0bleeding under atezolizumab\u2013bevacizumab in patients with <scp>HCC<\/scp>"],"prefix":"10.1111","volume":"42","author":[{"given":"Edouard","family":"Larrey","sequence":"first","affiliation":[{"name":"AP\u2010HP Sorbonne Universit\u00e9, H\u00f4pital Universitaire Piti\u00e9\u2010Salp\u00eatri\u00e8re, Service d'H\u00e9pato\u2010gastroent\u00e9rologie  Paris 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