Recompensation in patients with autoimmune hepatitis-related decompensated cirrhosis following immunosuppressive therapy

In this study, we aimed to evaluate the incidence, predictors, and prognostic significance of recompensation in autoimmune hepatitis (AIH)-related decompensated cirrhosis following immunosuppressive therapy (IST). We retrospectively analyzed patients with AIH 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. 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 (hazard ratio [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. Recompensation was achieved in approximately one-third of patients with AIH-related decompensated cirrhosis undergoing IST, 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. The predictors and long-term prognostic implications of recompensation in patients with autoimmune hepatitis (AIH)-related decompensated cirrhosis remain unclear. 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. We identified ascites (as the sole decompensating event), lower IgG levels, higher bilirubin levels and higher platelet counts as independent predictors of recompensation. These findings can be used by clinicians to identify the patients most likely to benefit from immunosuppressive therapy.