Clinical course of HCV-associated liver cirrhosis after viral eradication in transplant candidates

Objective : to investigate markers of liver injury ( MELD-Na and Child–Turcotte–Pugh [CTP] scores) before and after treatment with direct-acting antiviral (DAA) therapy, and to characterize clinical outcomes of HCV-associated decompensated liver cirrhosis following viral eradication in liver transplant (LT) candidates. Materials and methods . A prospective comparative study was conducted in 320 patients with decompensated cirrhosis listed for LT. Demographic, clinical, and laboratory parameters were analyzed, including MELD-Na and CTP scores, severity of hepatic encephalopathy, ascites, number of bleeding episodes, and occurrence of complications. Assessments were performed prior to HCV therapy and 12 months after achieving sustained virologic response (SVR). Subgroup analyses included patients who transitioned to compensated cirrhosis (n = 113) and those who remained or progressed to decompensated cirrhosis (n = 207). Cumulative risks were evaluated using Cox proportional hazards regression in univariate and multivariate models. Results . After 12 months of follow-up following the achievement of SVR, significant increases were observed in white blood cell and platelet counts, as well as serum albumin levels. In parallel, creatinine, international normalized ratio (INR), and bilirubin levels decreased. There was also a reduction in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity, along with improvements in the severity of ascites and hepatic encephalopathy, a decrease in the number of bleeding episodes, and lower CTP and MELD-Na scores. Predictors of further decompensation of cirrhosis included decreased serum sodium level, increased severity of liver injury on CT imaging, greater severity of ascites and hepatic encephalopathy, and a higher number of complications during follow-up.