End-stage liver disease occurs when the complications associated with liver disease can no longer be controlled through medical treatment. The most viable option for those suffering from end-stage liver disease is a liver transplant.
When the harmful effects of liver disease become irreversible, as in chronic alcoholism and serious liver infections, a doctor may diagnose end-stage liver disease. It's characterised by excessive cirrhosis, or scarring, of the liver, which divides the organ into irregular islands until, eventually, complete liver failure occurs.
Levels of Severity
The severity of end-stage liver disease is best monitored and determined by using the model for end-stage liver disease (MELD). Doctors use patients' MELD scores to prioritise sufferers so that those with the fewest remaining years of life can be moved up on the transplant waiting list. MELD scores range from 6 (longest expected lifespan) to 40 (shortest expected lifespan). They're calculated using the patient's bilirubin level (a measure of how well the liver is excreting bile), prothrombin time (which measures how fast blood clots) and creatinine level (a measure of kidney function).
According to the Centers for Disease Control and Prevention, chronic liver disease and cirrhosis were the twelfth-leading cause of death in the United States in 2006. Because alcohol is primarily metabolised in the liver, continued drinking will cause additional damaging of healthy tissue and precipitate end-stage liver disease. Abstinence from alcohol may be the single biggest lifesaving step patients with liver disease can take.
Recent efforts in tissue engineering attempt to provide replacement liver tissue for patients with end-stage liver disease. Successfully replacing damaged liver tissue would enable patients to regain use of the organ. Unfortunately, research has been hindered by the inability to provide a sustainable artificial blood supply, which is necessary to simulate the exchanges of essential nutrients and gases.
Lack of Donors
Because of the shortage of liver donors, approximately 1,500 people awaiting a transplant each year will die. Of the estimated 17,000 people on the liver transplant waiting list in 2005, only 5,000 received transplants that year.