Cirrhosis once viewed as irreversible, can improve after effective treatment, but recovery may not be complete or permanent. Researchers from China propose recognizing recompensation as a distinct treatment-related disease state and distinguishing stable from unstable recovery. Evidence across liver diseases shows that recompensation improves outcomes compared with persistent decompensation, while some patients later relapse. The framework could support more consistent research, clinical assessment, and long-term surveillance for patients recovering after cirrhosis treatment.
Cirrhosis has traditionally been viewed as a progressive condition in which complications, such as abdominal fluid accumulation, internal bleeding from enlarged veins, or hepatic encephalopathy, mark a point of no return. Effective treatment of the underlying cause has changed this view. Some patients can regain liver function and resolve these complications, a process known as recompensation. However, recovery is not always complete or permanent, highlighting the need to define this treatment-related state more clearly.
Addressing this challenge, a research team led by Professor Hong You and Dr. Bingqiong Wang from the Liver Research Center, Beijing Friendship Hospital, Capital Medical University, China, reviewed evidence on recompensation across major causes of cirrhosis and examined its criteria, frequency, predictors, biological basis, prognosis, and long-term management. The researchers propose viewing recompensation as a distinct disease state and distinguishing stable from unstable recompensation. The study will be published in the journal Portal Hypertension & Cirrhosis on Month Day, 2026.
Under the Baveno VII consensus, recompensation requires control of the underlying cause, sustained resolution of complications without supportive treatment, and stable improvement in liver function. A meta-analysis of 27 studies involving 9,063 patients found a pooled recompensation prevalence of about 35%, with estimates around 50% for hepatitis B virus-related cirrhosis and 15% for primary biliary cholangitis. In one hepatitis B study, 56.2% of 283 treatment-naïve patients receiving entecavir met Baveno VII criteria after 120 weeks. Among patients with alcohol-related cirrhosis, 31.1% achieved recompensation in a multicenter study.
Recovery also depends on factors beyond controlling the underlying disease. Better liver function, fewer previous decompensation events, and lower portal hypertension burden were generally associated with a greater likelihood of recompensation. Cohorts with a mean Model for End-Stage Liver Disease score below 15 had a pooled recompensation rate of 48%, compared with 19% among cohorts with scores of 15 or higher. Biological improvement may accompany clinical recovery in 19 patients with alcohol-related cirrhosis who had paired measurements, median hepatic venous pressure gradient fell from 19 to 9 mmHg, although 59% of 29 patients retained clinically significant portal hypertension.
“Recompensation reflects meaningful improvement after effective treatment, but it should not automatically be interpreted as complete reversal of cirrhosis,” says Prof. You. “ Recognizing it as a distinct treatment-related state may help describe recovery more consistently and identify patients who remain at risk.”
The review also indicates that recompensation can be unstable. In a hepatitis B cohort, 86.8% of patients who achieved recompensation by Week 120 maintained it during extended follow-up, while 13.2% developed hepatocellular carcinoma, further decompensation, or died. Another study identified unstable recompensation in 24.3% of patients. Five-year rates of hepatocellular carcinoma or all-cause mortality were 10.1% for stable recompensation, 14.7% for unstable recompensation, and 27.3% for persistent decompensation.
“Patients who improve after cirrhosis treatment may still carry residual risks from portal hypertension, limited liver reserve, and liver cancer ,” says Dr. Wang. “ Continued surveillance is therefore important even when clinical signs of decompensation have resolved.”
Overall, the authors propose four states after control of the underlying cause: compensated cirrhosis, stable recompensation, unstable recompensation, and persistent decompensation. They emphasize that this framework requires prospective validation, particularly beyond hepatitis B. Future research should establish objective markers, validate expanded criteria, clarify mechanisms of fibrosis regression and portal-pressure reduction, and determine whether different recovery trajectories require different monitoring strategies.
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Reference
DOI: https://doi.org/10.1002/poh2.70070
About Professor Hong You from Capital Medical University, China
Dr. Hong You is a Professor at the Liver Research Center, Beijing Friendship Hospital, Capital Medical University, China. She is the Vice President of the Chinese Society of Hepatology, Chinese Medical Association. She obtained a Doctor of Medicine degree in Internal Medicine (Gastroenterology) in 1999. As an academic researcher, she has an h-index of 22, has authored 186 papers, and has received 329 citations. She conducted postdoctoral research at the University of Arkansas for Medical Sciences in 2000. She was the principal investigator for three recent studies involving hepatitis, liver fibrosis, and NASH, and has authored many journal articles addressing liver cirrhosis.
About Dr. Bingqiong Wang from Capital Medical University, China
Dr. Bingqiong Wang is a Medical Researcher at the Liver Research Center, Beijing Friendship Hospital, Capital Medical University, China. This institution houses China's National Clinical Research Center for Digestive Diseases in Beijing, China. Specializing in hepatology, chronic liver disease, and translational medicine, her research focuses on liver fibrosis, liver cirrhosis, and hepatic recompensation trajectories. Additionally, she evaluates non-invasive assessment markers, including liver stiffness measurement cutoffs, to improve patient outcomes. Her work also targets hepatocellular carcinoma prediction models to advance early detection. Through these clinical efforts, Dr. Wang contributes to innovative diagnostic strategies and therapeutic management for complex liver conditions globally.
Portal Hypertension & Cirrhosis
Literature review
Not applicable
Recompensation of Cirrhosis: A New Treatment‐Related Disease State
11-Oct-2026
The authors declare no conflicts of interest.