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. 2024 Apr;59(8):962-972.
doi: 10.1111/apt.17908. Epub 2024 Feb 26.

Evaluation of potential hepatic recompensation criteria in patients with PBC and decompensated cirrhosis

Benedikt Silvester Hofer  1   2   3 , Lukas Burghart  3   4 , Emina Halilbasic  1   3 , Benedikt Simbrunner  1   2   3 , Oleksandr Petrenko  1   3 , Mattias Mandorfer  1   2   3 , Albert Friedrich Stättermayer  1   2   3 , Michael Trauner  1   3 , Thomas Reiberger  1   2   3
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Evaluation of potential hepatic recompensation criteria in patients with PBC and decompensated cirrhosis

Benedikt Silvester Hofer et al. Aliment Pharmacol Ther. 2024 Apr.

Abstract

Background: Aetiological therapy improves liver function and may enable hepatic recompensation in decompensated cirrhosis.

Aims: We explored the potential for recompensation in patients with decompensated primary biliary cholangitis (PBC) - considering a biochemical response to ursodeoxycholic acid (UDCA) according to Paris-II criteria as a surrogate for successful aetiological treatment.

Methods: Patients with PBC were retrospectively included at the time of first decompensation. Recompensation was defined as (i) resolution of ascites and hepatic encephalopathy (HE) despite discontinuation of diuretic/HE therapy, (ii) absence of variceal bleeding and (iii) sustained liver function improvement.

Results: In total, 42 patients with PBC with decompensated cirrhosis (age: 63.5 [IQR: 51.9-69.2] years; 88.1% female; MELD-Na: 13.5 [IQR: 11.0-15.0]) were included and followed for 41.9 (IQR: 11.0-70.9) months after decompensation. Seven patients (16.7%) achieved recompensation. Lower MELD-Na (subdistribution hazard ratio [SHR]: 0.90; p = 0.047), bilirubin (SHR per mg/dL: 0.44; p = 0.005) and alkaline phosphatase (SHR per 10 U/L: 0.67; p = 0.001) at decompensation, as well as variceal bleeding as decompensating event (SHR: 4.37; p = 0.069), were linked to a higher probability of recompensation. Overall, 33 patients were treated with UDCA for ≥1 year and 12 (36%) achieved Paris-II response criteria. Recompensation occurred in 5/12 (41.7%) and in 2/21 (9.5%) patients with vs. without UDCA response at 1 year, respectively. Recompensation was linked to a numerically improved transplant-free survival (HR: 0.46; p = 0.335). Nonetheless, 4/7 recompensated patients presented with liver-related complications after developing hepatic malignancy and/or portal vein thrombosis and 2 eventually died.

Conclusions: Patients with PBC and decompensated cirrhosis may achieve hepatic recompensation under UDCA therapy. However, since liver-related complications still occur after recompensation, patients should remain under close follow-up.

Keywords: Baveno VII; advanced chronic liver disease; cholestatic liver disease; disease regression; hepatic recompensation.

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