Mandorfer M, Kozbial K, Schwabl P, et al. - Among patients with portal hypertension (PH) who achieved sustained virologic response (SVR) to interferon-free therapy, researchers investigated how the development of hepatic decompensation is influenced by pretreatment hepatic venous pressure gradient (HVPG), changes in HVPG, and posttreatment HVPG. Additionally, they assessed transient elastography and von Willebrand factor to platelet ratio as noninvasive means to monitor PH evolution. Overall 90 patients with HVPG ≥ 6 mmHg were included. They found that an improved prognostication in patients with pretreatment clinically significant PH was enabled by a reevaluation of HVPG after SVR. In most of these patients, they detected an ‘immediate' HVPG-reduction ≥ 10%, which was related to a clinical benefit because it avoided hepatic decompensation. For interventions that lower portal pressure by reducing intrahepatic resistance, the use of HVPG as a surrogate endpoint was supported.