Management of End-stage Liver Disease

Major complications of cirrhosis include the development of ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, variceal hemorrhage, hepatic encephalopathy, and hepatocellular carcinoma. Careful evaluation and management of ascites and varices with judicious use of prophylactic therapy can improve survival. Diagnosis of hepatic encephalopathy can lead to appropriate intervention without protein restriction. Patients should undergo hepatocellular carcinoma surveillance routinely every 6 months. The development of any decompensating event should prompt referral to a liver transplant center.