Recompensation in patients with autoimmune hepatitis-related decompensated cirrhosis following immunosuppressive therapy
Yu Chen, Haoyu Wen, You Li, Weituo Zhang, Tianyu Mao, Chenyi Jiang, Huayang Zhang, Yujie Zhou, Xiting Pu, Bo Li, Jun Zhang, Yan Li, Min Lian, Sheng Li, Can‐Jie Guo, Qixia Wang, Qi Miao, Jing Hua, Hai Li, Ruqi Tang, Christopher L. Bowlus, M. Eric Gershwin, Zhengrui You, Xiao Xiao, Xiong Ma
Abstract
Background & Aims This study aimed to evaluate the incidence, predictors, and prognostic significance of recompensation in autoimmune hepatitis (AIH)-related decompensated cirrhosis following immunosuppressive therapy (IST). Methods We retrospectively analyzed AIH patients at first decompensation. Recompensation, defined using modified Baveno VII criteria, required clinical resolution (≥12 months without ascites, variceal bleeding, or hepatic encephalopathy, with liver function restored to Child-Pugh A) along with aetiological suppression (complete biochemical response under IST). Predictors of recompensation were identified using multivariate regression, and survival outcomes were compared among compensated, recompensated, and non-recompensated groups. Results A total of 258 patients with AIH-related decompensated cirrhosis were included (median follow-up: 47 months, IQR: 28-75). Clinical resolution was achieved by 124 patients (48.1%), while 68 patients (30.9% of 220 treated with IST) met criteria for recompensation. Predictors of recompensation included ascites as the only complication (HR=14.40, 95% CI: 4.17-49.64, p < 0.001), lower IgG levels (HR=0.90, 95% CI: 0.89-0.96, p < 0.001), higher bilirubin levels (HR=1.04, 95% CI: 1.00-1.08, p = 0.030), and higher platelet counts (HR=1.01, 95% CI: 1.00-1.01, p = 0.039). Patients achieving recompensation experienced a significantly reduced risk of liver transplantation or death (HR=0.07, 95% CI: 0.01-0.50, p = 0.009), with survival outcomes comparable to those of compensated patients. Conclusions Recompensation was achieved in approximately one-third of patients with AIH-related decompensated cirrhosis undergoing immunosuppressive therapy, leading to markedly improved transplant-free survival. Predictors of recompensation included having ascites as the sole complication, lower IgG levels, higher bilirubin levels, and higher platelet counts. Impact and implications This study demonstrates that recompensation is achievable in patients with AIH-related decompensated cirrhosis and is associated with significant long-term benefits, including improved survival and reduced transplantation needs. Clinicians should consider immunosuppressive therapy, particularly in patients with favorable clinical profiles such as ascites as the sole complication, lower IgG levels, and higher bilirubin and platelet counts.