Long‐Term Outcomes of Sofosbuvir/Velpatasvir Treatment for Hepatitis C Virus‐Related Decompensated Cirrhosis: A Retrospective Multicenter Cohort Study

BACKGROUND: Sofosbuvir/velpatasvir (SOF/VEL) treatment for hepatitis C virus (HCV)-related decompensated cirrhosis has been shown to achieve a high sustained virologic response (SVR) rate and to improve liver function. However, limited data are available regarding the association between improvements in liver function and long-term survival. This multicenter study aimed to evaluate longitudinal changes in liver function and factors associated with long-term prognosis in patients treated with SOF/VEL. METHODS: Ninety-one patients who received SOF/VEL for HCV-related decompensated cirrhosis between March 2019 and December 2021 were enrolled. SVR rates, changes in Child-Pugh scores at 12, 24, 48, 72, and 120 weeks after treatment, changes in albumin-bilirubin (ALBI) scores, and overall survival (OS) were assessed. The impact of post-treatment ALBI improvement on prognosis was examined, and its predictive ability for 60-month OS was evaluated using receiver operating characteristic analysis. Survival was compared using the Kaplan-Meier method. RESULTS: The median age was 68.0 years; 36.3% of patients were male, and 24.2% had a history of hepatocellular carcinoma. SVR was achieved in 96.7% of patients. The median observation period was 57.0 months (IQR, 43.0-72.0), and 27 patients (29.7%) died during the observation period. Child-Pugh scores improved from the end of treatment and continued to improve; at 120 weeks, 55.9% of patients had scores of 5 or 6. The median OS was not reached, and the 5-year survival rate was 73.2%. ALBI improvement predicted 60-month OS with a sensitivity of 0.494, a specificity of 0.851, and an optimal cutoff value of a decrease in ALBI score of ≥ 0.103. Patients with ALBI improvement showed significantly better OS. CONCLUSIONS: SOF/VEL therapy achieved high SVR rates and demonstrated that post-treatment improvement in the ALBI score is strongly associated with a favorable long-term prognosis in patients with decompensated cirrhosis.