Removal/suppression of the primary aetiological factor includes sustained virological response (SVR) in patients with HCV infection, HBV suppression in the absence of HDV coinfection in patients with chronic HBV infection, and long-term abstinence from alcohol in patients with alcohol-related liver disease.
The definition and impact of the removal/suppression of the primary aetiological factor in other ACLDs is less well established.
Overweight/obesity, diabetes, and alcohol consumption are important contributors to liver disease progression even after removal/suppression of the primary aetiological factor and should be addressed.
Removal/suppression of the primary aetiological factor leads to potentially meaningful decreases in HVPG in most patients and substantially reduces the risk of hepatic decompensation.
Absence/resolution of CSPH following removal/suppression of the primary aetiological factor prevents hepatic decompensation.
The optimal percent/absolute decrease in HVPG associated with a reduction in hepatic decompensation following the removal/suppression of the primary aetiological factor in patients with cACLD and CSPH has yet to be established.
In the absence of co-factors, patients with HCV-induced cACLD who achieve SVR and show consistent post-treatment improvements with LSM values of <12 kPa and PLT >150×109/L can be discharged from portal hypertension surveillance (LSM and endoscopy), as they do not have CSPH and are at negligible risk of hepatic decompensation. In these patients, HCC surveillance should continue until further data is available.
The Baveno VI criteria (i.e., LSM <20 kPa and PLT >150×109/L) can be used to rule out high-risk varices in patients with HCV- and HBV-induced cACLD who achieved SVR and viral suppression, respectively.
Patients with cACLD on NSBB therapy with no evident CSPH (LSM <25 kPa) after removal/suppression of the primary aetiological factor, should be considered for repeat endoscopy, preferably after 1–2 years. In the absence of varices, NSBB therapy can be discontinued.
Corrigendum to ‘Baveno VII – Renewing consensus in portal hypertension’ [J Hepatol (2022) 959-974] Journal of Hepatology, Vol. 77, Issue 2