Recompensation in decompensated cirrhosis

Recompensation of decompensated cirrhosis has been defined by the Baveno consensus as control or cure of the main underlying cause; resolution of clinical manifestations, including ascites and hepatic encephalopathy, without the use of prophylactic medications, and without variceal bleeding for 12 months; and restoration of hepatic function. Cure and recompensation are usually associated with regression of liver fibrosis. Recompensation can occur when hepatitis C virus is eradicated, if hepatitis B virus infection (without hepatitis D co-infection) is suppressed, and following persistent alcohol abstinence in patients with alcohol-associated cirrhosis. Although cirrhosis related to metabolic dysfunction-associated steatotic liver disease can improve following lifestyle or pharmacotherapy-assisted weight loss, and autoimmune liver disease can respond to immunosuppression, it is unclear if true recompensation can be achieved in such patients. Recompensation of cirrhosis could be an achievable clinical target, offsetting costs of management of advanced liver disease, and decreasing the need for liver transplantation. Consequently, public health policies should pursue programmes that promote alcohol cessation, eliminate viral hepatitis, and address obesity.