Incidence and implications of abstinence-induced recompensation in alcohol-related cirrhosis

Hepatic recompensation, as defined by Baveno VII, is a novel clinical concept reflecting the potential for disease regression and resolution of decompensating events in patients with cirrhosis once the underlying aetiological factor is removed or controlled. In this multicentre study, sustained alcohol abstinence led to recompensation in one third of patients with decompensated alcohol-related cirrhosis within 5 years, particularly if abstinence was achieved early and in the absence of further decompensation. Recompensation markedly improved outcomes, with a negligible residual risk of liver-related death and hepatocellular carcinoma when abstinence is maintained. These findings support personalised treatment approaches in decompensated alcohol-related cirrhosis by helping identify patients at risk of progression or with potential for regression.