Baveno VII criteria for recompensation predict transplant-free survival in patients with hepatitis B-related decompensated cirrhosis
Vicki Wing‐Ki Hui, Grace Lai–Hung Wong, Vincent Wai‐Sun Wong, Henry Lik‐Yuen Chan, Jimmy Che‐To Lai, Yee‐Kit Tse, Mandy Sze‐Man Lai, Tsz‐Fai Yam, Dongrong Li, Xiaodan Fan, Terry Cheuk‐Fung Yip
Abstract
Background & AimsThe latest Baveno VII consensus provided guidance for determining patients who have truly recompensated from hepatic decompensation. This study aimed to evaluate patients’ transplant-free survival in three different stages of cirrhosis.MethodsAll patients with chronic hepatitis B virus (HBV) infection and liver cirrhosis treated with oral nucleos(t)ide analogues from March 2006 to December 2022 were identified from a territory-wide database in Hong Kong. Patients with follow-up duration less than one year were excluded. Subjects were classified into three mutually exclusive groups: 1. no decompensated events (i.e. compensated group); 2. decompensated events occurred (i.e. decompensated group); or 3. decompensated events occurred followed by recompensation according to Baveno VII criteria (i.e. recompensated group). A time-dependent Cox proportional hazard model was adopted for evaluation. The follow-up period was 5 years.Results4,701 cirrhotic HBV patients who were treated with entecavir, tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide fumarate (TAF) were identified. During a median follow-up of 5 [interquartile range 3.7, 5] years), 3,327 (70.8%), 1,347 (29.2%) and 265 (5.6%) patients had compensated, decompensated, and recompensated cirrhosis, respectively, at least once before the end of the study. In the time-dependent multivariable model, the recompensated group had similar transplant-free survival compared to the compensated group (adjusted hazard ratio [aHR] 1.16; 95% confidence interval [CI] 0.72-1.86; p =0.536). The five-year transplant-free survival rate was 89.3% for the compensated group, while it was 76.0% for the recompensated group, reflecting a minimal difference between the two groups.ConclusionsThe clinical significance of recompensation of cirrhosis in improving patient outcomes for those suffering from CHB infection was highlighted in this study. Early identification and treatment with nucleos(t)ide analogues might promote hepatic recompensation and thus reduce mortality in patients with CHB.Impact and ImplicationsThe latest Baveno VII consensus introduces the new concept of hepatic recompensation, which refers to the reversal of the structural and functional changes of cirrhosis after removal, cure, or suppression of the aetiology of cirrhosis. It is essential to investigate the transplant-free survival rates of patients who are able to achieve hepatic recompensation, as this has significant implications for the medical resources required to manage liver failure and transplantation. This study features the clinical significance of hepatic recompensation by comparing patient outcomes of those who achieve it to those who do not. The early identification and use of antiviral treatment with nucleos(t)ide analogues is a pivotal strategy to promote hepatic recompensation, which has the potential to significantly reduce mortality rates in patients with chronic HBV infection and ultimately aid in the elimination of hepatitis.