Outpatient management after hospitalisation for acute decompensation of cirrhosis: A practical guide

Table 1 Etiological treatments in decompensated patients

Cause	Treatment option
Alcohol	Discontinue alcohol consumption (long-term abstinence for more than six months)
HBV	Early HBV suppression with nucleoside analogues
HDV	Bulevirtide (not currently approved for patients with DeCi)
HCV	Sofosbuvir-velpatasvir. PI-based regimens in case of treatment failure (?)
MASLD	Weight loss, exercise, management of comorbidities. Resmetirom, semaglutide (?), tirzepatide (?)
PBC	Ursodeoxycholic acid, fibrates
AIH	Corticosteroids

HBV: Hepatitis B virus; HDV: Hepatitis D virus; HCV: Hepatitis C virus; MASLD: Metabolic-associated steatotic liver disease; PBC: Primary biliary cholangitis; AIH: Autoimmune hepatitis; DeCi: Decompensated cirrhosis; PI: Protease inhibitor.

Table 2 Portal vein thrombosis management guidelines from major hepatology associations

	Baveno VII[3]	AASLD[45]	ACG[46]	EASL[165]
Indication for screening	LT candidates concomitantly with HCC screening	-	Upon diagnosis of cirrhosis First decompensation	LT candidates concomitantly with HCC screening
Indication for treatment	Recent (< 6 months) PVT completely or partially occluded Symptomatic PVT Potential LT candidates	Recent (< 6 months) PVT (or SMV) completely or partially occluded Symptomatic (ischemic) PVT	Evidence of thrombophilia Progression into the mesenteric veins Evidence of bowel ischemia	SMV thrombosis or history of bowel ischemia Potential LT candidates

AASLD: American Association for the Study of Liver Diseases; ACG: American College of Gastroenterology; EASL: European Association for the Study of the Liver; LT: Liver transplantation; HCC: Hepatocellular carcinoma; PVT: Portal vein thrombosis; SMV: Superior mesenteric vein.

Table 3 Proposed vaccination schedule for patients with decompensated cirrhosis

Vaccination	Schedule
HAV	At 0 and 6 months (2 doses)
HBV	At 0, 1 and 6 months (3 doses)
Influenza	Annually
COVID-19 - Moderna (mRNA 1273)	At 0 days and 28 days (2 doses)
COVID-19 - BioNTech/Pfizer (BNT162b2 mRNA)	At 0 days and 21 days (2 doses)
VZV	At 0 months and 2 months (2 doses)
Pneumococcus	PCV15 followed by PPSV23 1 year after

HAV: Hepatitis A virus; HBV: Hepatitis B virus; COVID-19: Coronavirus disease 2019; VZV: Varicella zoster virus; PCV15: 15-valent pneumococcal conjugate vaccine; PPSV23: 23-valent pneumococcal polysaccharide vaccine.