End-stage liver disease

End-stage liver disease is when your liver is damaged beyond repair due to chronic liver disease or acute liver failure

Key points

End-stage liver disease is the final stage of some long-term liver diseases and acute liver failure
Cirrhosis (scarring) of the liver happens with long-term liver diseases
Patients can have cirrhosis of the liver with or without symptoms
Patients with severe symptoms of cirrhosis may benefit from a liver transplant

What is end-stage liver disease?

End-stage liver disease is when your liver is damaged beyond repair due to chronic liver disease or acute liver failure. Cirrhosis of the liver happens with long-term liver diseases. Cirrhosis is scarring of the liver. This usually happens after the other stages of damage from conditions that affect the liver.

Diseases that may lead to end-stage liver disease

Alcohol-related liver disease
Non-alcoholic fatty liver disease (NAFLD)
Viral hepatitis (e.g. hepatitis B, hepatitis C)
Primary biliary cholangitis, sometimes called primary biliary cirrhosis (PBC)
Primary sclerosing cholangitis (PSC)
Autoimmune hepatitis (AIH)
Primary hepatocellular carcinoma (HCC) on a background of chronic liver disease
Occasionally the cause of end-stage liver disease is unknown

Scarring of the liver

This is known as cirrhosis.

Patients with end-stage liver disease are usually said to have either compensated cirrhosis or decompensated cirrhosis.

Decompensated cirrhosis

This is also known as decompensated liver disease. Patients with decompensated cirrhosis have more severe symptoms and complications.

Symptoms of decompensated cirrhosis might include:

Yellow discolouration of the skin (jaundice)
Fluid retention with abdominal distension (ascites)
Leg swelling (oedema)
Confusion (encephalopathy)
Bleeding from abnormal blood vessels (varices) in the oesophagus and stomach (internal bleeding)

Patients with decompensated cirrhosis are at increased risk of dying from complications of liver disease. Their symptoms can severely affect their quality of life. In these circumstances, liver transplantation can be beneficial.

Compensated cirrhosis

The liver of patients with compensated cirrhosis still works relatively well, despite the scarring that comes with end-stage liver disease. These patients often have no or few symptoms, but still need to be treated. They are not usually candidates for a liver transplant.

However, sometimes patients with well-compensated cirrhosis can develop hepatocellular cancer (HCC) in their liver. Under certain circumstances they may be offered a liver transplant as a potentially curative treatment, if other treatments are not suitable.

Liver disease and kidney failure

Patients with end-stage liver disease can also develop kidney failure. This is often reversible with a liver transplant. But some patients may need a combined liver and kidney transplant.

Acute liver failure

This is when a patient develops sudden and severe liver failure without a history of long-term liver disease. In these cases, an urgent liver transplant may be their only life-saving treatment.