Is liver cirrhosis reversible?

From the Guidelines

Liver cirrhosis can be partially reversible in some cases, but complete reversal is uncommon once advanced scarring has occurred, and the most recent evidence suggests that early treatment of the underlying cause is crucial to halt progression and improve liver function. According to the most recent study 1, decompensated cirrhosis can be managed with antiviral therapy, which can improve liver function, decrease the need for liver transplantation, and improve survival.

Key Points to Consider

• Early-stage cirrhosis may show improvement if the underlying cause is removed, such as stopping alcohol consumption in alcoholic liver disease, treating viral hepatitis with antiviral medications, or managing autoimmune hepatitis with immunosuppressants.
• Weight loss of 7-10% in non-alcoholic fatty liver disease can also reduce inflammation and fibrosis.
• The liver has remarkable regenerative capacity, allowing healthy liver tissue to replace damaged areas when the injurious agent is removed.
• Advanced cirrhosis with extensive scarring and nodule formation is generally considered irreversible.
• Regular monitoring with liver function tests and imaging is essential for anyone with liver disease to track progression or improvement.

Treatment Approaches

• Antiviral therapy can modify the natural history of decompensated cirrhosis and improve liver function.
• Liver transplantation should be considered in patients with decompensated liver cirrhosis.
• Oral antiviral therapy is the treatment of choice if HBV DNA is detectable by PCR tests.
• An antiviral drug with a potent antiviral efficacy and high genetic barrier to drug resistance should be used.

Important Considerations

• Prompt treatment is required in patients with decompensated liver cirrhosis.
• Clinical improvement often requires 3–6 months of antiviral therapy, and progression to hepatic failure is possible even during antiviral therapy in some patients.
• Liver transplantation should be considered together with antiviral therapy in patients with decompensated liver cirrhosis.

From the Research

Reversibility of Liver Cirrhosis

• Liver cirrhosis is a pathologic scarring of liver tissue that leads to impaired liver function, and it can result from any etiology of chronic liver inflammation 2.
• According to recent studies, cirrhosis is potentially reversible through management of the cause, such as nonalcoholic fatty liver disease, viral hepatitis, or alcohol use 2, 3, 4, 5.
• The reversibility of cirrhosis usually occurs in patients with short-lived liver disease, after the successful treatment of the underlying liver damage 3.
• Clinical evidence supports the idea of the reversibility of cirrhosis in patients with different aetiologies of advanced hepatic disease, including viral, autoimmune, and metabolic/infiltrative liver disease 5.
• Cirrhosis is more likely to regress if it is recent, there is effective and long-lasting viral suppression, an internal capacity to regenerate, and no vascular thrombosis 6.

Factors Influencing Reversibility

• The underlying cause of liver injury must be eliminated for cirrhosis to be reversed 3, 6.
• Effective and long-lasting viral suppression is crucial for the regression of cirrhosis 6.
• The duration of liver disease and the extent of fibrosis also play a role in determining the reversibility of cirrhosis 3, 6.
• Novel therapeutic strategies are under investigation to target specific steps in the process of fibrogenesis with the aim of reversing advanced fibrosis/cirrhosis 5.

Clinical Implications

• Clinicians should counsel patients about alcohol use, obesity management, and prevention of infection to prevent the progression of liver disease 2.
• Drugs with potential for hepatotoxicity should be avoided, and clinical assessment with laboratory tests and calculation of the Child-Pugh and Model for End-stage Liver Disease (MELD) scores should occur every 6 months 2.
• Evaluation for liver transplantation is indicated for patients with a MELD score of 15 or greater, complications of cirrhosis, or hepatocellular carcinoma 2.