Giorgio Maria Saracco

Background & Aims limited evidence is available to guide hepatologists regarding endoscopic surveillance of oesophageal varices (EV) in Hepatitis C Virus (HCV)‐positive cirrhotic patients achieving a sustained virologic response. To address these issues, we conducted a long‐term prospective study on 427 HCV‐positive cirrhotic patients successfully treated by Direct Antiviral Agents (DAAs). Methods Patients were divided into two groups according to their baseline Baveno VI status: Group 1 (92, 21.5%, favourable Baveno VI status) and Group 2 (335, 78.5%, unfavourable Baveno VI status). Each patient underwent baseline endoscopy and was endoscopically monitored for a median follow‐up of 65.2 months according to Baveno VI recommendations. Results About 4.3% of Group 1 patients showed baseline EV compared with 30.1% of Group 2 patients ( p < .0001). No patients belonging to Group 1 without baseline EV developed EV at follow‐up endoscopy compared with 6.5% in Group 2 patients ( p = .02); 69/107 (64.5%) patients with baseline EV showed small varices. During the endoscopic follow‐up, EV disappeared/improved in 36 (33.6%), were stable in 39 (36.4%) and worsened in 32 (29.9%) patients, all belonging to Group 2 ( p = .001). Improvement in Baveno VI status was observed in 118/335 (35.2%, p < .0001) of Group 2 patients and among those without pre‐therapy EV, none developed EV throughout the follow‐up. Conclusions HCV‐positive cirrhotic patients cured by DAAs showing baseline favourable Baveno VI status and no worsening during follow‐up can safely avoid endoscopic screening and surveillance. Patients having unfavourable Baveno VI status without baseline EV who improve their status may suspend further endoscopic surveillance.

Renal dysfunction often complicates the course of liver disease, resulting in higher morbidity and mortality. The accurate assessment of kidney function in these patients is essential to early identify, stage and treat renal impairment as well as to better predict the prognosis, prioritize the patients for liver transplantation and decide whether to opt for simultaneous liver–kidney transplants. This review analyses the available tools for direct or indirect assessment of glomerular filtration rate, focusing on the flaws and strengths of each method in the specific setting of cirrhosis. The aim is to deliver a clear‐cut view on this complex issue, trying to point out which strategies to prefer in this context, especially in the peculiar setting of liver transplantation. Moreover, a glance is given at future promising tools for glomerular filtration rate assessment, including new biomarkers and new equations specifically modelled for the cirrhotic population.