Predictors of long-term changes in mALBI grade in cirrhotic patients after sustained virological response with direct-acting antiviral treatment

The long-term changes in liver function and outcomes in patients with cirrhosis after achieving a sustained virological response (SVR) with direct-acting antiviral (DAA) treatment remain unclear. Between 2014 and 2020, we screened 2,030 patients with chronic hepatitis C virus (HCV) infection who achieved an SVR with DAA treatment at participating institutions. Among them, 820 patients had cirrhosis. The median follow-up period was 70 (range, 14–89) months. After excluding patients without hepatocellular carcinoma (HCC) and those who were followed up for less than 1 year after the end of treatment (EOT), 542 patients were included in this retrospective multicenter study. Higher modified albumin-bilirubin (mALBI) grade at SVR at 12 weeks after treatment completion (SVR12) was significantly associated with increased hepatocellular carcinoma incidence and total mortality. Of 157 patients with baseline mALBI grade 2b/3, 83 improved to grade 1/2a by SVR12. Patients were subsequently divided into four patient groups: A (early improvement, n = 73), B (re-exacerbation, n = 10), C (late improvement, n = 19), and D (no improvement, n = 55) based on mALBI changes over 3 years. Predictors for group D were albumin level at SVR12 ( p = 0.004) and prothrombin time at SVR12 ( p = 0.010), with cut-off values on receiver-operating characteristic curve analyses of 3.3 g/dL and 63%, respectively. Improvement in mALBI grade after SVR decreases the risk of HCC and improves outcomes. For patients with persistently impaired albumin and prothrombin time at SVR12, further recovery in liver function is unlikely. These findings highlight the importance of mALBI-based surveillance strategies for cirrhotic patients following SVR.