The transition to end-of-life care in end-stage liver disease

In the United States, end-stage liver disease (ESLD) is the 12th leading cause of death and the 7th leading cause of death in people between the ages of 25 and 64 years. Complications of ESLD such as ascites, variceal hemorrhage, hepatic encephalopathy, and renal impairment primarily account for these deaths. Patients with ESLD require increasingly complex medical support and manifest a spectrum of complications and symptoms that have significant impact on both survival and quality of life.Because of the possibility of liver transplantation, patients with ESLD are more likely to receive aggressive care despite constant declining poor health. In current practice, discussions and referrals to palliative or hospice care are not done until the hope of recovery is diminished, which is often in the last weeks of life. There is little literature on the appropriate palliative care approach for those with ESLD. The purpose of this article is to summarize the transitions often experienced by patients with ESLD as they approach end-of-life, compare and contrast these transitions to other life limiting illnesses, and review current palliative care strategies recommended for ESLD.