Alcohol Abstinence Enables Hepatic Recompensation in One-Third of Patients With Decompensated Cirrhosis
Sustained alcohol abstinence led to hepatic recompensation in approximately one-third of patients with decompensated alcohol-related cirrhosis over five years, according to a large multicenter study evaluating long-term outcomes under the Baveno VII criteria. The findings underscore the potential for meaningful disease regression when alcohol cessation is achieved early.
The study included 633 patients from 17 centers who were decompensated at the time of abstinence. Recompensation required sustained abstinence for at least three months, resolution of ascites and hepatic encephalopathy off therapy, absence of variceal bleeding for one year, and restoration of liver function. Over a median follow-up of more than three years, 31.1% of patients achieved recompensation, with cumulative incidence reaching 33.8% at five years.
Early abstinence was a key determinant. Patients who stopped drinking within one month of decompensation were significantly more likely to achieve recompensation. Conversely, further episodes of decompensation reduced the likelihood of recovery. The authors reported that “alcohol abstinence enabled recompensation in one third of patients with decompensated alcohol-related cirrhosis,” particularly when achieved early and without subsequent deterioration.
Recompensation was strongly associated with improved survival. During follow-up, 123 patients died, more than half from liver-related causes. However, no recompensated patient who maintained abstinence died from liver-related complications, and recompensation independently predicted lower all-cause mortality. Notably, no cases of hepatocellular carcinoma occurred among patients who achieved recompensation.
The investigators concluded that “recompensation led to a significant survival benefit with maintained abstinence, with a negligible residual risk of liver-related death and HCC.”
Reference
Hofer BS, Tonon M, Buttler L, et al. Incidence and implications of abstinence-induced recompensation in alcohol-related cirrhosis. J Hepatol. Published online January 22, 2026. doi:10.1016/j.jhep.2026.01.007
