Patients with decompensated alcohol-related cirrhosis who abstained from alcoholic drinking achieve recompensation, which is associated with survival benefits when abstinence is sustained, reveals a study.
“Recompensation fundamentally changed the clinical course of cirrhosis, leading to significantly improved survival rates and a negligible residual risk for liver-related death and hepatocellular carcinoma (HCC) when abstinence was maintained,” the investigators said.
A total of 633 patients with decompensated alcohol-related cirrhosis (median age 55 years, 71.7 percent male) recruited from 17 centres at the time of abstinence up to December 2022 were included in this multicentre study.
Recompensation was defined according to the Baveno VII criteria: (i) sustained abstinence (≥3 months), (ii) resolution of ascites and hepatic encephalopathy off therapy, (iii) absence of variceal bleeding for 1 year, and (iv) restored liver function (Child-Pugh A or MELD <10).
Of the patients, 40.8 percent had alcohol-associated hepatitis on top of cirrhosis. The median MELD was 19, with nearly half of the participants (47.2 percent) progressing to decompensation at abstinence. The median time from index decompensation to abstinence was 0.2 months. [J Hepatol 2026;84:1077-1088]
About one in three patients (n=197, 31.1 percent) achieved recompensation (cumulative incidence: 12.3 percent at 1 year, 23.4 percent at 2 years, and 33.8 percent at 5 years) over 36.3 months of follow-up.
In both supervised and machine-learning models, individuals with early abstinence (within 1 month of decompensation; adjusted subdistribution hazard ratio [aSHR], 2.042), higher aspartate aminotransferase (aSHR per 10 U/L increase, 1.011), and gamma-glutamyltransferase (aSHR per 10 U/L increase, 1.004; p<0.001 for all) were more likely to achieve recompensation.
On the other hand, patients with further decompensation had a lower likelihood of attaining recompensation (aSHR, 0.650; p=0.013).
Some 123 patients died during follow-up, with the majority being liver-related (56.1 percent). Notably, recompensation independently contributed to a reduced risk of all-cause mortality (aHR, 0.255; p=0.001). No recompensated patients with sustained alcohol abstinence died of liver-related cause or developed HCC.
“Alcohol abstinence enabled hepatic recompensation in approximately one-third of patients with decompensated alcohol-related cirrhosis, particularly when abstinence was achieved early and in the absence of further decompensation,” the investigators said.
Timely treatment
Early alcohol abstinence within 1 month of index decompensation was one of the primary predictors of recompensation in this analysis, resulting in a twofold higher likelihood of achieving recompensation.
“This finding is consistent with previous observations in hepatitis B virus, where early initiation of nucleos(t)ide analogue therapy after first decompensation significantly increased the probability of subsequent recompensation, thus highlighting the importance of timely and effective treatment of the underlying aetiological driver,” the investigators said. [Aliment Pharmacol Ther 2022;55:83-96]
Conversely, the presence of further decompensation at the time of abstinence led to a lower likelihood of recompensation.
“These observations align with prior studies on recompensation in alcohol-related liver disease (ALD), ALD transplant delisting, and recompensation in other aetiologies, all of which identified disease severity as a limiting factor for recompensation,” the investigators said. [Liver Int 2023;43:2220-2231; J Hepatol 2021;75:275-283; Gastroenterology 2024;167:1429-1445]
Furthermore, “despite ongoing efforts to expand liver disease screening, most patients were diagnosed with cirrhosis and ALD only at the time of hepatic decompensation, underscoring the unmet need for improved screening strategies aimed at earlier identification of patients with ALD,” they added.