The end stage of years of repetitive cycles of inflammation and repair is advanced fibrosis and cirrhosis with the attendant complications, which are challenging to treat and seriously affect patients’ quality of life. Additionally, end-stage cirrhotic liver disease is associated, of course, with the development of hepatocellular cancer.
Transplantation represents a real success story of the latter part of the 20th century because it has transformed the prognosis of diseases, which until comparatively recently were considered fatal.

By definition, this group of patients has an appalling prognosis. Patients with end-stage liver disease require increasingly complex medical support and manifest a spectrum of complications that significantly impact quality of life, such as the development of ascites, encephalopathy, and cachexia.

At the same time, the flexibility to deploy pharmaceutical-based approaches is limited by the capacity of the end-stage diseased liver to metabolize many drugs commonly used in advanced disease, such as opiates.

Adapted from Iredale J. End-stage chronic liver disease: time to define a good death. Hepatology, June 2008. Internet. Accessed on June 21, 2016.