Cirrhosis is not the end

Receiving a diagnosis of liver cirrhosis can be a confusing, scary, and frustrating experience. After any diagnosis, it is often in the days after the doctor’s appointment that a patient thinks of questions. Likewise, often at the time of a new diagnosis, some people don’t retain the conversation they had with their provider. Sometimes, searching the internet about cirrhosis can lead to confusion and fear because there is a massive amount of misinformation out there. Even with the best information available, cirrhosis has many different causes, treatments and outcomes. After a diagnosis of cirrhosis, it is common to think about the stage of the disease and what that means for the future. 

Cirrhosis is a term for “advanced scar tissue” in the liver. A major reason why there is so much confusion about cirrhosis is that scar tissue in the liver is staged from 0 to 4. This staging system is NOT the same as the staging system for cancers. For the liver, babies have stage 0 scar tissue in the liver. Stage 1-3 scar tissue may occur throughout the course of living everyday life, where we are exposed to toxins like alcohol and environmental chemicals. Having diabetes is also a major risk factor for developing scar tissue in the liver. Just as the arteries harden with age, the liver can harden with age too. When the scar tissue forms a fishnet pattern throughout the liver, the scar tissue is classified as stage 4, aka cirrhosis. 

Stage 4 liver scar tissue is not the same as other stage 4 diseases such as cancer. While the liver may have cirrhosis, it does not mean that the liver is in its final stages. Cirrhosis can be silent for years. Studies are showing that many people die with cirrhosis rather than of cirrhosis. People who have this type of silent cirrhosis are classified as compensated. They may have no obvious signs of having a liver problem. They also may not benefit from a liver transplant. If followed closely by a provider who specializes in caring for the liver, life can be relatively normal. With regular follow up and testing, some of the more severe complications of cirrhosis can be avoided. With regular follow up, if the liver does become decompensated, early referral to a liver transplant center is very important. At UofL, I am proud to be a part of a team that cares for patients with mildly abnormal liver tests to patients 25 years after liver transplant, and everything in between. While we are approaching the milestone of 1,000 liver transplants at our center, every day we celebrate helping people to avoid transplants by healing the liver they have. 

In closing, a diagnosis of cirrhosis is not the end. Often cirrhosis can be managed without a liver transplant and if a liver transplant would provide benefit, we can help make that a reality. At UofL Health and UofL Physicians – Digestive & Liver Health, we can help every step of the way.  

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About Loretta Jophlin, M.D., Ph.D.

Dr. Loretta Jophlin completed both her medical and Ph.D. degrees at the Medical University of South Carolina (MUSC) in Charleston, South Carolina. She did her internal medicine residency at the Mount Sinai Hospital in New York City. She completed her gastroenterology and hepatology fellowship at MUSC, where she was also awarded an NIH F32 Ruth L. Kirschstein National Research Service Award for postdoctoral research in liver disease and cirrhosis. In 2017, she did an advanced fellowship in transplant hepatology at the Mayo Clinic in Rochester, Minnesota and practiced for a couple of years while continuing laboratory research aimed at cirrhosis. She joined the faculty at the University of Louisville in December 2020 to practice clinical hepatology and to start her research laboratory. Also part of UofL Physicians – Digestive & Liver Health, she works alongside Dr. Craig McClain and Dr. Matt Cave who are internationally renowned physician-scientists studying alcohol and environmental liver diseases. Her chief interests include caring for individuals with liver problems ranging from abnormal liver function tests to decompensated cirrhosis, early liver transplantation for acute alcohol-related hepatitis, clinical trials and scientific research on mechanisms of fatty liver disease and cirrhosis.

All posts by Loretta Jophlin, M.D., Ph.D.