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Care at the Close of Life: Evidence and Experience
Stephen J. McPhee, Margaret A. Winker, Michael W. Rabow, Steven Z. Pantilat, Amy J. Markowitz
Part C Disease Management
Chapter 16. Integrating Palliative Care for Liver Transplant Candidates: “Too Well for Transplant, Too Sick for Life”
Anne M. Larson, MD, Randall Curtis, MD, MPH
Viral Hepatitis and ESLD


Topics Discussed: end stage liver disease, liver transplantation

Excerpt: "Chronic viral hepatitis is defined as hepatitis that persists for more than 6 months. Hepatitis B and C viruses can cause chronic hepatitis (Table 16-1). Viral hepatitis is characterized by an inflammatory reaction and diffuse hepatocyte damage varying in degree from subclinical mild injury to progressive fibrosis with cirrhosis or, in rare cases, massive hepatocyte destruction leading to fatal acute liver failure. Affected patients may present with fatigue, malaise, mild abdominal pain, and jaundice or signs of ESLD, including thrombocytopenia, spider angiomata, palmar erythema, ascites, peripheral edema, splenomegaly, gynecomastia, or hepatic encephalopathy. Extrahepatic manifestations are common, including arthralgias, arthritis, and rash. The frequency and patterns of viral hepatitis transmission vary markedly around the world (Table 16-1). Hepatitis B virus–induced chronic liver disease causes serious sequelae from cirrhosis and HCC for 15% to 40% of affected individuals.8 Hepatitis B virus is the cause of 60% to 80% of HCC cases worldwide. During a 5-year period, 12% to 20% of patients with chronic hepatitis B will progress to cirrhosis,9,10 20% to 23% of patients with compensated cirrhosis will progress to decompensated cirrhosis, and 5% to 15% of patients with cirrhosis will develop HCC.11-15 Once decompensation occurs, 5-year survival is reduced from 84% to 14%.11,15,16 Orthotopic liver transplantation (OLT) is a well-established treatment for HBV-induced liver failure.17..."
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