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      Advancing hepatic recompensation: Baveno VII criteria and therapeutic innovations in liver cirrhosis management

      editorial

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          Abstract

          The Baveno VII criteria redefine the management of decompensated liver cirrhosis, introducing the concept of hepatic recompensation marking a significant departure from the conventional view of irreversible decline. Central to this concept is addressing the underlying cause of cirrhosis through tailored therapies, including antivirals and lifestyle modifications. Studies on alcohol, hepatitis C virus, and hepatitis B virus-related cirrhosis demonstrate the efficacy of these interventions in improving liver function and patient outcomes. Transjugular intrahepatic portosystemic shunt (TIPS) emerges as a promising intervention, effectively resolving complications of portal hypertension and facilitating recompensation. However, optimal timing and patient selection for TIPS remain unresolved. Despite challenges, TIPS offers renewed hope for hepatic recompensation, marking a significant advancement in cirrhosis management. Further research is needed to refine its implementation and maximize its benefits. In conclusion, TIPS stands as a promising avenue for improving hepatic function and patient outcomes in decompensated liver cirrhosis within the framework of the Baveno VII criteria.

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          BAVENO VII - RENEWING CONSENSUS IN PORTAL HYPERTENSION

          Roberto de Franchis, Jaime Bosch, Guadalupe Garcia-Tsao … (2021)
          To expand on the work of previous meetings, a virtual Baveno VII workshop was organised for October 2021. Among patients with compensated cirrhosis or compensated advanced chronic liver disease (cACLD - defined at the Baveno VI conference), the presence or absence of clinically significant portal hypertension (CSPH) is associated with differing outcomes, including risk of death, and different diagnostic and therapeutic needs. Accordingly, the Baveno VII workshop was entitled "Personalized Care for Portal Hypertension". The main fields of discussion were the relevance and indications for measuring the hepatic venous pressure gradient as a gold standard, the use of non-invasive tools for the diagnosis of cACLD and CSPH, the impact of aetiological and non-aetiological therapies on the course of cirrhosis, the prevention of the first episode of decompensation, the management of an acute bleeding episode, the prevention of further decompensation, as well as the diagnosis and management of splanchnic vein thrombosis and other vascular disorders of the liver. For each of these 9 topics, a thorough review of the medical literature was performed, and a series of consensus statements/recommendations were discussed and agreed upon. A summary of the most important conclusions/recommendations derived from the workshop is reported here. The statements are classified as unchanged, changed, and new in relation to Baveno VI.
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            Transjugular Intrahepatic Portosystemic Shunts With Covered Stents Increase Transplant-Free Survival of Patients With Cirrhosis and Recurrent Ascites.

            Christophe Bureau, Pauline Cabarrou, Philippe Otal … (2017)
            There is controversy over the ability of transjugular intrahepatic portosystemic shunts (TIPS) to increase survival times of patients with cirrhosis and refractory ascites. The high rate of shunt dysfunction with the use of uncovered stents counteracts the benefits of TIPS. We performed a randomized controlled trial to determine the effects of TIPS with stents covered with polytetrafluoroethylene in these patients.
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              Hepatitis B virus-related decompensated liver cirrhosis: benefits of antiviral therapy.

              Cheng-Yuan Peng, Rong-Nan Chien, Yun-Fan Liaw (2012)
              Following development of liver cirrhosis in patients with chronic hepatitis B, liver disease may continue to progress and decompensation or hepatocellular carcinoma (HCC) may occur, especially in those with active viral replication. Decompensation may manifest with jaundice, ascites, variceal bleeding or hepatic encephalopathy. Earlier studies have shown that the prognosis of decompensated cirrhosis is usually poor with a 5-year survival rate at 14-35% under conventional standard of care. The approval of oral antiviral agents has greatly improved the prognosis, as demonstrated in several cohort studies and randomized clinical trials involving therapy with lamivudine, adefovir dipivoxil, entecavir, telbivudine, or tenofovir disoproxil fumarate. Oral antiviral agents are effective in restoring liver function and improving survival in patients with decompensated cirrhosis especially if therapy is initiated early enough. These agents are generally well tolerated without significant side effects. However, their preventive effect in HCC development has yet to be convincingly demonstrated. Given their known resistance profiles, entecavir and tenofovir should be considered as the first-line therapy for patients with HBV-related decompensated cirrhosis. Copyright © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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                Author and article information

                Contributors
                Lorenzo Ridola
                Sara Del Cioppo
                Journal
                Journal ID (nlm-ta): World J Gastroenterol
                Journal ID (iso-abbrev): World J Gastroenterol
                Journal ID (publisher-id): WJG
                Title: World Journal of Gastroenterology
                Publisher: Baishideng Publishing Group Inc
                ISSN (Print): 1007-9327
                ISSN (Electronic): 2219-2840
                Publication date (Print): 21 June 2024
                Publication date (Electronic): 21 June 2024
                Volume: 30
                Issue: 23
                Pages: 2954-2958
                Affiliations
                Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Rome 00185, Italy. lorenzo.ridola@ 123456uniroma1.it
                Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Rome 00185, Italy
                Author notes

                Author contributions: Del Cioppo S was responsible for conceptualization and manuscript writing; Ridola L was responsible for conceptualization, manuscript writing, key revisions of important knowledge content, and final approval.

                Corresponding author: Lorenzo Ridola, PhD, Associate Professor, Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Viale dell'Università 37, Rome 00185, Italy. lorenzo.ridola@ 123456uniroma1.it

                Article
                Other ID: jWJG.v30.i23.pg2954 Publisher-manuscript ID: 94524
                DOI: 10.3748/wjg.v30.i23.2954
                PMC ID: 11212703
                SO-VID: 557dfaa2-6c5d-4a09-95bc-dc82f998a03c
                Copyright © ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                Date received : 19 March 2024
                Date revision received : 14 May 2024
                Date accepted : 22 May 2024
                Categories
                Subject: Editorial

                Keywords: hepatic recompensation,baveno vii,transjugular intrahepatic portosystemic shunt,portal hypertension,cirrhosis,decompensation
                Data availability:
                Keywords: hepatic recompensation, baveno vii, transjugular intrahepatic portosystemic shunt, portal hypertension, cirrhosis, decompensation

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