Factors associated with improvement in MELD score after antiviral treatment in patients with chronic hepatitis B

Background and Aims Improvement in Model for End‐Stage Liver Disease (MELD) score during antiviral treatment is associated with reduced hepatic decompensation and death in patients with chronic hepatitis B (CHB)‐related cirrhosis. We aimed to identify factors associated with transplant‐free survival and on‐treatment MELD score improvement. Methods We identified patients with CHB‐related cirrhosis and MELD score ≥ 15 at the start of entecavir and/or tenofovir disoproxil fumarate treatment between 2005 and 2017. The primary endpoint was transplant‐free survival at month 6. The secondary endpoints at month 6 were transplant‐free survival with > 5‐point improvement in MELD score and transplant‐free survival with MELD score < 15. Results Of 999 cirrhotic CHB patients, 605 (60.6%) achieved transplant‐free survival at month 6. Proportion of transplant‐free survival at month 6 stabilized at 10% in patients with high MELD. Patients who achieved transplant‐free survival at month 6 were younger, had lower MELD score, lower alanine aminotransferase (ALT), and higher albumin at baseline. Of 605 patients with transplant‐free survival, 276 (45.6%) achieved > 5‐point improvement in MELD score; 183 (30.2%) had 1‐point to 5‐point improvement in MELD score; 146 (24.1%) had no improvement or a worsened MELD score. Also, 321 (53.1%) patients with transplant‐free survival had a MELD score < 15 at month 6. Conclusion On top of lower MELD score, patients with CHB‐related cirrhosis who are younger, have higher albumin, and lower ALT are more likely to achieve transplant‐free survival after 6 months of antiviral treatment.