Consistent and permanent abstinence from alcohol can lead to the regression of existing liver-related complications, even in cases of advanced alcohol-related cirrhosis. This is shown by an international multicentre study led by MedUni Vienna, which was recently published in the renowned Journal of Hepatology. Up to one third of patients with already decompensated alcohol-related cirrhosis were able to achieve so-called "re-compensation" through consistent abstinence from alcohol – i.e., the complete resolution of liver-related complications with simultaneous recovery of liver function. In addition, the study identifies the factors that are crucial for this recovery of liver function.
Cirrhosis is characterised by progressive scarring of the liver. In Western countries, it is often caused by excessive alcohol consumption and leads to serious complications in many affected individuals, such as abdominal fluid accumulation (ascites), altered mental states (encephalopathy) and bleeding from varicose veins in the oesophagus (variceal bleeding). Traditionally, the occurrence of such complications, known as decompensation events, was considered a sign that cirrhosis had become irreversible. The results now published challenge this dogma.
The study by the research team led by Benedikt Hofer and Thomas Reiberger (Division of Gastroenterology and Hepatology at the Department of Medicine III at MedUni Vienna and University Hospital Vienna) included 633 patients with alcohol-related cirrhosis from 17 specialist centres in Europe and Asia. All patients had begun abstaining from alcohol after experiencing decompensation events.
The course of the disease is reversible
Within five years, around one third of patients achieved a complete resolution of all liver-related complications with simultaneous improvement in liver function – a condition known as "re-compensation". "Our data clearly show that even after the onset of severe complications, the course of cirrhosis is not necessarily irreversible," explains lead author Benedikt Hofer. In addition to the initial severity of the liver disease, the decisive factor in achieving recompensation was, above all, complete and early abstinence from alcohol. Study leader Thomas Reiberger emphasises: "Abstaining from alcohol can not only halt the progression of liver disease, but in many patients can even lead to an improvement in cirrhosis. However, it is crucial that abstinence from alcohol is maintained immediately after the occurrence of complications – this can more than double the chance of recompensation."
Dramatic survival advantage through recompensation
The clinical impact of recompensation on the survival of the patients in the study was impressive: none of the recompensated patients who remained abstinent from alcohol died of liver-related causes. The risk of developing liver cancer was also significantly reduced in this group, and overall mortality was significantly lower – clinically relevant results that were additionally highlighted as "Research Highlights" in the journal Nature Reviews Gastroenterology and Hepatology. Thomas Reiberger continues: "Recompensation is no longer a purely theoretical concept, but a clinically increasingly relevant condition that can fundamentally improve the prognosis of patients despite advanced cirrhosis."
Abstinence from alcohol at the centre of therapy
The study underscores the central role of complete and permanent abstinence from alcohol as the most effective therapeutic intervention for alcohol-related liver disease. At the same time, the results also highlight health policy aspects: structured support to achieve and maintain alcohol abstinence is crucial for the prognosis of these patients – especially against the backdrop of current budget cuts in the area of addiction support and abstinence programmes.
"A relapse into alcohol abuse significantly worsens the prognosis," says Benedikt Hofer, adding: "So if savings are made in abstinence support, not only are preventable deaths risked, but also high costs for the medical treatment of advanced liver disease and its complications."
