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Liver Transplant Resources: Understanding Cirrhosis

Cirrhosis is scarring of the liver. It is the end result of chronic inflammation taking place in the liver. It is a natural response the body has in attempting to heal itself. Unfortunately, cirrhosis of the liver is inflammation and repair of the liver that has gotten out of control. There are many different causes of cirrhosis. There is a popular misconception that alcohol abuse is the major cause of cirrhosis. From a statistical standpoint, alcohol accounts for approximately 49% of all cases of cirrhosis. The other common causes of cirrhosis include nonalcoholic fatty liver disease, chronic hepatitis B, chronic hepatitis C, autoimmune hepatitis, iron overload secondary to hereditary hemochromatosis, alpha one antitrypsin deficiency, Wilson's disease, and disorders of the bile ducts such as primary biliary cirrhosis, and sclerosing cholangitis.

Cirrhosis tends to develop slowly over time. Depending on the underlying disease, it could take many years or decades until cirrhosis develops. Once cirrhosis develops, the majority of the liver is replaced by nonfunctioning scar tissue. This scar tissue causes a number of alterations on how the liver functions.

Once cirrhosis develops, blood flow through the liver is impaired. A condition called portal hypertension develops, which results in a number of complications commonly seen in patients with cirrhosis. These complications include the development of hepatic encephalopathy, ascites, low platelet count, and the risk of developing and bleeding from esophageal or gastric varices.

Patients with cirrhosis are at risk for developing hepatocellular carcinoma, which is a primary cancer that develops in the liver.

Symptoms of cirrhosis are quite numerous, but typically include weakness, fatigue, loss of muscle mass, a decrease in libido, edema and swelling, and the development of confusion related to hepatic encephalopathy. As mentioned earlier, the development of liver cancer is associated with all cases of cirrhosis.

For patients that are being evaluated for liver transplant, the number one disease leading to cirrhosis that is transplanted currently is chronic hepatitis C. it is anticipated that in the next 5 years, fatty liver disease, a result of the worldwide obesity epidemic, may surpass hepatitis C as the most common liver condition that is transplanted. Other common diseases leading to cirrhosis that require liver transplant include alcoholic liver disease, nonalcoholic fatty liver disease, autoimmune hepatitis, hereditary hemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency, chronic hepatitis B, and fulminant liver failure due to hepatitis A, medications, and other unknown viruses.