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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