Palliative care for patients with end-stage liver disease ineligible for liver transplantation

The number of patients with end-stage liver disease (ESLD) is increasing, while the number of donor organs available for transplantation remains stable. Patients with ESLD are subject to numerous physical and psychosocial symptoms that negatively affect their health and perceived quality of life. Physicians caring for patients with ESLD must be familiar with palliative measures for common complications of ESLD, such as ascites, pruritus, hepatic encephalopathy, fatigue, and anorexia. Early discussions between the patient and physician about advance directives and the goals of therapy are important. Hospice care is appropriate for many patients with ESLD regardless of whether there is a complicating hepatocellular malignancy.