Recompensation in patients with autoimmune hepatitis-related decompensated cirrhosis following immunosuppressive therapy
Background & Aims: 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). Methods: We retrospectively analyzed patients with AIH at f...
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2025-09-01
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| author | Yu Chen Haoyu Wen You Li Weituo Zhang Tianyu Mao Chenyi Jiang Huayang Zhang Yujie Zhou Xiting Pu Bo Li Jun Zhang Li Yan Min Lian Li Sheng Canjie Guo Qixia Wang Qi Miao Jing Hua Hai Li Ruqi Tang Christopher L. Bowlus M. Eric Gershwin Zhengrui You Xiao Xiao Xiong Ma |
| author_facet | Yu Chen Haoyu Wen You Li Weituo Zhang Tianyu Mao Chenyi Jiang Huayang Zhang Yujie Zhou Xiting Pu Bo Li Jun Zhang Li Yan Min Lian Li Sheng Canjie Guo Qixia Wang Qi Miao Jing Hua Hai Li Ruqi Tang Christopher L. Bowlus M. Eric Gershwin Zhengrui You Xiao Xiao Xiong Ma |
| author_sort | Yu Chen |
| collection | DOAJ |
| description | Background & Aims: 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). Methods: 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. Results: 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. Conclusions: 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. Impact and implications: 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. |
| format | Article |
| id | doaj-art-836424bf0458499caa585674b3eef599 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-09-01 |
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| series | JHEP Reports |
| spelling | doaj-art-836424bf0458499caa585674b3eef5992025-08-20T03:59:37ZengElsevierJHEP Reports2589-55592025-09-017910149610.1016/j.jhepr.2025.101496Recompensation in patients with autoimmune hepatitis-related decompensated cirrhosis following immunosuppressive therapyYu Chen0Haoyu Wen1You Li2Weituo Zhang3Tianyu Mao4Chenyi Jiang5Huayang Zhang6Yujie Zhou7Xiting Pu8Bo Li9Jun Zhang10Li Yan11Min Lian12Li Sheng13Canjie Guo14Qixia Wang15Qi Miao16Jing Hua17Hai Li18Ruqi Tang19Christopher L. Bowlus20M. Eric Gershwin21Zhengrui You22Xiao Xiao23Xiong Ma24Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaSchool of Public Health, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, China; Division of Infectious Diseases, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, China; Division of Infectious Diseases, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, University of California Davis School of Medicine, Davis, USADivision of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USADivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, ChinaDivision of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, China; Corresponding authors. Address: Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai 200001, China. (X. Ma), or Division of Infectious Diseases, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 145 Middle Shandong Road, Shanghai 200001, China. (X. Xiao).Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, China; Institute of Aging & Tissue Regeneration, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Corresponding authors. Address: Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, 145 Middle Shandong Road, Shanghai 200001, China. (X. Ma), or Division of Infectious Diseases, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 145 Middle Shandong Road, Shanghai 200001, China. (X. Xiao).Background & Aims: 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). Methods: 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. Results: 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. Conclusions: 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. Impact and implications: 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.http://www.sciencedirect.com/science/article/pii/S2589555925001740Autoimmune HepatitisCirrhosisDecompensationRecompensation |
| spellingShingle | Yu Chen Haoyu Wen You Li Weituo Zhang Tianyu Mao Chenyi Jiang Huayang Zhang Yujie Zhou Xiting Pu Bo Li Jun Zhang Li Yan Min Lian Li Sheng Canjie Guo Qixia Wang Qi Miao Jing Hua Hai Li Ruqi Tang Christopher L. Bowlus M. Eric Gershwin Zhengrui You Xiao Xiao Xiong Ma Recompensation in patients with autoimmune hepatitis-related decompensated cirrhosis following immunosuppressive therapy JHEP Reports Autoimmune Hepatitis Cirrhosis Decompensation Recompensation |
| title | Recompensation in patients with autoimmune hepatitis-related decompensated cirrhosis following immunosuppressive therapy |
| title_full | Recompensation in patients with autoimmune hepatitis-related decompensated cirrhosis following immunosuppressive therapy |
| title_fullStr | Recompensation in patients with autoimmune hepatitis-related decompensated cirrhosis following immunosuppressive therapy |
| title_full_unstemmed | Recompensation in patients with autoimmune hepatitis-related decompensated cirrhosis following immunosuppressive therapy |
| title_short | Recompensation in patients with autoimmune hepatitis-related decompensated cirrhosis following immunosuppressive therapy |
| title_sort | recompensation in patients with autoimmune hepatitis related decompensated cirrhosis following immunosuppressive therapy |
| topic | Autoimmune Hepatitis Cirrhosis Decompensation Recompensation |
| url | http://www.sciencedirect.com/science/article/pii/S2589555925001740 |
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