Palliative Care in End Stage Liver Disease

Chronic liver disease is a significant global cause of morbidity and mortality. While early-stage liver cirrhosis is often asymptomatic, it can progress to a decompensated phase known as end stage liver disease (ESLD). ESLD poses a substantial global health burden, accounting for over two million deaths annually. Despite advancements in hepatology, many patients are ineligible for liver transplantation – the only curative treatment - resulting in a high symptom burden, diminished quality of life and frequent hospitalizations. However palliative care remains underutilized in this population. Globally, the integration of palliative care into ESLD is impeded by several barriers. Certain factors – such as advanced age, presence of hepatocellular carcinoma (HCC), and transplant listing status – have been associated with higher rates of palliative care referral. This review provides a comprehensive analysis of current literature, emphasizing the benefits of palliative care interventions in ESLD, including improved symptom control and enhanced quality of life. It also underscores the impact on caregivers and healthcare systems, notably in reducing hospital readmissions. We advocate for a paradigm shift toward proactive, patient-centered models that integrate symptom management, advance care planning, and psychosocial support alongside disease-specific treatments for patients with ESLD.