Palliative Care and Liver Transplantation

The role of palliative care (PC) specialists has largely been limited to end-of-life care in the inpatient setting. Patients with advanced liver disease have significant symptom burden, including pain, dyspnea, cramping, pruritus, depression, anxiety, and progressive debilitation and frailty – all of which result in poor health-related quality of life. A prospective observational study of patients listed for liver transplant who were admitted to a surgical intensive care unit (ICU) demonstrated that patients that underwent a structured PC intervention had increased rate of goals of care discussions, earlier do not resuscitate status, and decreased ICU length of stay. Despite the many benefits of PC, there remain multiple barriers that need to be addressed before it is routinely integrated into the care trajectory of patients with advanced liver disease. Acute kidney injury is a frequent complication of cirrhosis, occurring in approximately 20% of hospitalized patients with decompensated cirrhosis.