Preventive Approaches in Chronic Liver Diseases Part III: Decompensated Liver Cirrhosis

INTRODUCTION Liver cirrhosis (LC) is a relatively frequent cause of death in the United States accounting for more than 27,000 deaths per year as of 2002 (1). Medical complications are frequent in patients with LC and more so when the liver disease becomes decompensated (2). LC is considered decompensated when patients develop at least one complication of the disease (hepatic encephalopathy, gastrointestinal bleeding due to portal hypertension, ascites, coagulopathies, hepatocellular carcinoma or severe infections). Compensated LC becomes decompensated at a rate of about 5%–10% yearly (3). The major causes of death in patient with decompensated liver disease without liver transplantation are liver failure, hepatocellular carcinoma (HCC), variceal bleeding, infections and renal failure (3). Liver transplantation is a rapidly growing field. There have been more than 81,000 liver transplants in United States alone through the end of 2006 (4). The average oneand three-year survival in the U.S. is about 85.7% and 77.7% respectively (5). Liver transplantation remains the only prospect for long-term survival in patients with decompensated cirrhosis (6,7). Our main objective in this article is to provide evidence-based strategies to prevent complications of decompensated LC and provide the primary caregiver with strategies to detect and avoid possible complications for patients before liver transplantation. This manuscript is the last part of three articles dealing with preventive measure for liver disease by primary careA SPECIAL THREE-PART ARTICLE