Mandorfer M, Kozbial K, Schwabl P, et al. - Given that sustained virologic response (SVR) to interferon (IFN)-free therapies improve portal hypertension (PH), researchers ascertained if a reduction in hepatic venous pressure gradient (HVPG) after hepatitis C cure translates into a clinical benefit. In patients with PH who achieved SVR to IFN-free therapy, they evaluated the impact of pretreatment HVPG, changes in HVPG, and posttreatment HVPG on the development of hepatic decompensation. In addition, transient elastography (TE) and von Willebrand factor to platelet ratio (VITRO) were assessed as non-invasive methods for monitoring the evolution of PH. Study participants included 90 patients with HVPG ≥ 6 mmHg who had paired HVPG, TE, and VITRO assessments before and after IFN-free therapy. In patients with pretreatment CSPH, re-assessment of HVPG after SVR improved prognostication. In most of these patients, an ‘immediate' HVPG-decrease ≥ 10% was noted and was linked to a clinical advantage, as it avoided hepatic decompensation. These findings favor the use of HVPG as a surrogate endpoint for procedures by reducing intrahepatic resistance to reduced portal pressure.