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End stage liver disease

Cirrhosis is a process in which damaged or dead liver cells are replaced with scar tissue. Extensive scar tissue formation impairs flow of blood through the liver. This destroys even more cells and causes a loss of liver function.

Decompensated cirrhosis is when the scarring of the liver is so extensive that the parts of the liver that are still functioning efficiently can no longer compensate for the parts that are damaged. At this stage the liver will have nodules of scar tissue, which are visible on ultrasound. It will be shrunken in size and will no longer be able to carry out its essential functions. Once decompensated cirrhosis has occurred, serious complications are almost inevitable. There is usually a high frequency of readmissions to hospital.

Until recently it was thought that treating people with HCV-induced decompensated cirrhosis with pegylated interferon was not worthwhile. This was due to the low response rates, the risks of severe side effects and the possibility that treatment might accelerate the deterioration of the liver. But recent studies have indicated that this type of treatment may help those who have not had treatment before and who currently have few options other than liver transplantation.

A report given at EASL 2011 (European Association for the Study of the Liver) indicated that patients with advanced liver fibrosis or cirrhosis were more likely to achieve a successful treatment outcome when they added Boceprevir to standard therapy. There is now considerable expertise in performing liver transplants on HCV patients. Survival rates are about seventy percent after five years[1]. But the shortage of available donors means that transplants are only offered to the patient whose liver is thought to be in the last year of its life. (see liver transplants)

[1] - accessed 10.41am 01.04.2014

The overall risk of developing liver cancer or hepatocellular carcinoma (HCC) for people infected with HCV is relatively small. It usually develops decades after infection and is almost exclusively confined to people who have already progressed to cirrhosis. There are currently no exact figures showing the numbers of people with HCV who go on to develop liver cancer. At the moment though, it appears that around 5% of people who have cirrhosis will develop HCC each year.[2]

Once liver cancer does develop, the survival rates are very low. It is unlikely that someone with liver cancer will survive for more than five years unless they have surgery to remove the cancer or a liver transplant. Surgery is only possible if the cancer has not spread beyond the liver. Furthermore current guidelines on transplant mean that doctors may only suggest a liver transplant if you have:

  • · A single liver tumour that is less than 5cm across
  • · Up to 3 tumours that are all less than 3cm across
  • · A single tumour 5 to 7cm in size that has not grown for at least six months

This is why people who have cirrhosis should be screened for liver cancer every six months. Finding a tumour at an early stage significantly increases the chances of recovery.(see liver cancer)



Tome S, Lucey MR. Timing of liver transplantation in alcoholic cirrhosis. J Hepatol. 2003, 39: 302-307 accessed: 21.03.2012

Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis

J Thompson Coon,1* G Rogers,1 P Hewson,2 D Wright,2 R Anderson,1 M Cramp,3S Jackson,4 S Ryder,5 A Price6 and K Stein1

1 Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Exeter, UK
2 School of Mathematics and Statistics, University of Plymouth, UK
3 Hepatology Research Group, Peninsula Medical School, Exeter, UK
4 Radiology Department, Plymouth NHS Hospitals Trust, UK
5 Queen's Medical Centre, University of Nottingham, UK
6 Southampton Health Technology Assessments Group, University of Southampton, UK accessed 21.03.2012