Introduction The concept of recompensated cirrhosis has gained increasing importance with the advent of effective disease-modifying therapies for chronic liver disease, including antiviral treatment and sustained alcohol abstinence. As more patients experience meaningful clinical recovery, reassessing transplant candidacy and determining when liver transplantation may no longer be necessary have become major clinical challenges.
Introduction
The concept of recompensated cirrhosis has gained increasing importance with the advent of effective disease-modifying therapies for chronic liver disease, including antiviral treatment and sustained alcohol abstinence. As more patients experience meaningful clinical recovery, reassessing transplant candidacy and determining when liver transplantation may no longer be necessary have become major clinical challenges.
Problem Statement
Although recompensation is increasingly recognized as a relevant therapeutic endpoint, standardized real-world markers for durable clinical improvement remain poorly defined. Delisting for clinical improvement (DCI) from the liver transplant waitlist has been proposed as a potential surrogate for recompensation, but the durability of improvement and risk of subsequent clinical deterioration remain uncertain.
Summary
This large national cohort study demonstrates that delisting for clinical improvement occurs in a meaningful subset of liver transplant waitlist patients and may serve as a practical surrogate marker for recompensated cirrhosis. Rates of DCI varied substantially according to liver disease etiology, with the highest frequencies observed in hepatitis B, alcohol-associated liver disease and autoimmune hepatitis, reflecting the greater reversibility of these conditions under effective therapy or sustained disease control. Importantly, the study shows that true durable recompensation is not fully captured by MELD improvement alone. Patients achieving both MELD reduction and improvement in Child–Turcotte–Pugh class had the lowest risk of relisting, suggesting that combined biochemical and clinical recovery better defines stable recompensation. Notably, many patients delisted for improvement still retained significant underlying liver dysfunction, as fewer than half normalized to Child–Turcotte–Pugh class A. Relisting remained relatively uncommon overall but was frequently driven by hepatocellular carcinoma, emphasizing the continued oncologic vulnerability of cirrhotic patients despite hepatic improvement. Additional predictors of relapse included hypoalbuminemia, male sex and underlying disease etiology. Overall, the study supports a more nuanced and multidimensional approach to defining recompensated cirrhosis and provides important real-world evidence that integrated clinical improvement metrics may help guide safer liver transplant delisting decisions.
Introduction: Acute-on-chronic liver failure (ACLF) is characterized by overwhelming systemic inflammation and immune dysregulation, leading to high short-term mortality. This study used advanced single-cell and spatial transcriptomic technologies to define the immune landscape of ACLF...
Introduction: Despite advances in the management of portal hypertension, mortality after variceal bleeding remains high in patients with cirrhosis. Experimental and clinical studies suggest that statins may improve portal hypertension and hepatic vascular function. This...
Introduction: Acute liver failure (ALF) complicated by cerebral oedema carries a high risk of early mortality, primarily due to hyperammonemia and intracranial hypertension. The optimal timing of continuous renal replacement therapy (CRRT) in these critically...
Introduction: Hepatic encephalopathy (HE) is a major cause of hospitalization in patients with advanced liver disease and is associated with significant morbidity, mortality, and healthcare utilization. The management of HE extends beyond ammonia reduction and...
Introduction: Hepatic encephalopathy (HE) is one of the most common and debilitating neuropsychiatric complications of liver disease and portal-systemic shunting. It can present with a broad spectrum of manifestations, ranging from subtle cognitive impairment to...
Introduction: The belief that low or moderate alcohol consumption may confer cardiovascular or overall health benefits has influenced public health messaging for decades. However, emerging evidence has increasingly challenged this concept, particularly as improved analytical...
We are pioneers in clinical intelligence, dedicated to helping gastroenterologists harness the power of artificial intelligence to drive precision, efficiency, and patient growth.