End Stage Liver Disease

End stage liver disease, as the name implies, is the final stage of a progressive liver condition, such as cirrhosis of the liver, progressive hepatitis (e.g. viral hepatitis type C), or liver cancer. The ICD 9 code for end stage liver disease is 572.8.

End stage liver disease is a condition in which liver function is largely or entirely lost. It is a terminal condition unless a liver transplant is performed.

Model For End-Stage Liver Disease (MELD)

The Model for End-Stage Liver Disease (MELD) is a scoring system used to identify the final stages of liver disease, establish terminal prognosis, and serve as an allocation method for prioritizing liver transplants.

The score uses values for serum bilirubin, serum creatinine, and the international normalized ratio for prothrombin time (INR) to generate a single numerical score used to predict mortality from liver disease. Certain tweak factors occur with a diagnosis of liver cancer and when the patient has undergone repeated dialysis.

Symptoms

Unlike earlier stages of liver disease, end stage liver disease always causes overt symptoms. These include pain in various parts of the body, usually including pain in the upper abdominal cavity over the liver itself, but pains can occur in other areas, too. The liver is usually inflamed and, depending on the underlying cause of the liver failure, may present with scar tissue. Other symptoms include jaundice, dark-colored urine caused by a buildup of bilirubin, light-colored or gray stools. Rashes may appear on parts of the body. More severe symptoms can  result from complications of end-stage liver disease.

Complications

One fairly common complication is hepatic encephalopathy. This is a condition of reduced brain function resulting from the buildup of toxins in the bloodstream due to failure of liver function. Symptoms are often severe, and can include loss of consciousness, changes in behavior, impaired judgment, drowsiness, slurred speech, confusion, disorientation, eventually leading the patient to lapse into a coma. Sufferers from hepatic encephalopathy who become comatose die about 80 percent of the time.

Another complication is portal hypertension. This is caused by the inflammation and build-up of scar tissue and fibrotic tissue that characterizes certain kinds of progressive liver disease (such as cirrhosis). Reduced blood flow into the liver from the portal vein (the blood vessel carrying blood into the liver) can occur, resulting in localized hypertension (high blood pressure) in the portal vein and nearby blood vessels that carry the overflow. This can cause internal bleeding, potentially fatal.

Treatment Of End-Stage Liver Disease

End-stage liver disease is irreversible. There is no treatment for the condition other than a liver transplant. Liver transplant techniques have improved dramatically over the past few decades. The one-year survival rate, which was under 25 percent in the 1970s, has risen to over 80 percent today. Nevertheless, this is a formidably invasive, major, and difficult surgical procedure involving three surgeons and taking in most cases five to six hours. The main potential complication post-surgery is, as with all transplant procedures, rejection of the donor organ. Immunosuppression is necessary to prevent this from happening. However, the primary problem with liver transplants is availability of donors, generating a danger that the patient will die before a donor organ becomes available.

The classic liver transplant involves use of a whole liver from a deceased donor. This is still the most common form of the operation. However, new methods include “living donor” liver transplantation. In this procedure, the entire liver of the patient is removed, but it is  replaced with only a piece of the donor liver. A healthy liver has remarkable regenerative properties, and the donor’s liver normally regenerates within 4 to 6 weeks. The transplanted portion in the recipient also regenerates to full capacity. This greatly increases the availability of donors.