Incidence and Clinical Significance of Recompensation After HCV Cure
Georg Semmler, Sabela Lens, Álvaro Hidalgo‐Vega, Sonia Alonso López, Maria Perez-Perez, Elton Dajti, Martin Kabelitz, Paola Zanaga, Benedikt Hofer, Zoe Mariñó, Marisa Luisa Manzano, Isabel Payeras, Mònica Pons, Angelo Bruni, Alberto Zanetto, Lukas Burghart, D. Ecker, Lucie Simonis, Anna Pocurull, L. Fritz, Cristina Collazos, Daniela Neumayer, Lorenz Balcar, Mathias Jachs, Thomas Reiberger, Francesco Paolo Russo, Benjamin Maasoumy, Joan Genescà, Rafael Bañares, Xavier Forns, Inmaculada Piedra Fernández, Mattias Mandorfer, Adriana Maria Ahumada, Francesco Azzaroli, Sara Battistella, M. Cornberg, K. Deterding, Marie Griemsmann, Michael Gschwantler, Stefanie Hametner-Schreil, L Hartl, Julia Krawanja, Benjamin Mauz, Diego Rincón, Caroline Schwarz, Michael Schwarz, Benedikt Simbrunner, M Trauner, Clara Usón, Heiner Wedemeyer
Abstract
BACKGROUND & AIMS: Baveno VII has proposed criteria for cirrhosis recompensation, but their prognostic significance in decompensated patients cured of hepatitis C virus (HCV) deserves further investigation. Thus, we studied the incidence and impact of recompensation after HCV cure as well as its predictors. METHODS: A total of 2570 patients with advanced chronic liver disease (ACLD) from 10 European centers were retrospectively included, including 2209 and 361 patients with compensated ACLD and decompensated cirrhosis who achieved sustained virologic response to direct-acting antivirals (DAAs). The association between achieving recompensation and clinical outcomes (hepatocellular carcinoma [HCC], portal vein thrombosis [PVT], and [liver-related] death) was investigated. RESULTS: During a median follow-up of 8.4 years from treatment initiation, 132 patients (36.6%) achieved recompensation. Lower albumin levels and diabetes were negatively associated with achieving recompensation. The incidence rates of liver-related death (4.2 vs 8.8 per 100 patient-years) and PVT (2.7 vs 5.4) were substantially lower after recompensation vs in the nonrecompensated state, while HCC incidence remained high (3.9 vs 5.5). Compared with decompensated cirrhosis, achieving recompensation was independently associated with decreased risks of subsequent liver-related death (adjusted hazard ratio, 0.384; 95% confidence interval, 0.225-0.655) and of PVT (adjusted hazard ratio, 0.421; 95% confidence interval, 0.224-0.759), but both risks remained higher than in compensated ACLD. Importantly, HCC incidence was not reduced as compared with decompensated cirrhosis. CONCLUSIONS: Recompensation after HCV cure is associated with substantially decreased risks of (liver-related) mortality and PVT, but not of HCC.