Portal hypertension and its prognostic implications in patients with Wilson's disease

Summary Background and Aims Wilson's disease may progress to cirrhosis and clinically significant portal hypertension (CSPH). We aimed to assess the prevalence and prognostic impact of CSPH‐related features on hepatic decompensation and transplant‐free survival in patients with Wilson's disease. Methods and Results About 137 patients with Wilson's disease (Leipzig score ≥4), followed for a median observation period of 9.0 (3.9–17.7) years at the Vienna General Hospital, were included in this retrospective study. Overall, 49 (35.8%) developed features of CSPH: 14 (10.2%) varices, 40 (29.2%) splenomegaly, 20 (14.6%) ascites, 18 (13.1%) hepatic encephalopathy and 3 (2.2%) experienced acute variceal bleeding. Overall, 8 (5.8%) patients died, including three deaths caused by CSPH‐related complications. Within 10 years, compensated patients with features of CSPH developed more decompensation events (8.3% vs. 1.5% in patients without CSPH, p = 0.3) and had worse transplant‐free‐survival (91.7% vs. 98.6%), which further declined in patients with hepatic decompensation (26.7%, log‐rank: p < 0.0001). Patients with liver stiffness <15 kPa and normal platelets (≥150 G/L) were less likely to decompensate within 10 years (2.6% vs. 8.4%, p = 0.002) and had a better 10‐year transplant‐free‐survival (97.7% vs. 83.9%, p = 0.006). Conclusions Patients with Wilson's disease developing features of CSPH are at an increased risk for hepatic decompensation and liver‐related mortality, warranting for regular screening and timely initiation of effective CSPH‐directed treatments.