Postgraduate Course 

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Keeping the Patient With End-stage Cirrhosis Alive
Course Directors:  
Arun J. Sanyal, MD    Kris Kowdley, MD     Hugo E. Vargas, MD

Cirrhosis is a leading cause of death in the general population, and liver transplantation is the only approach that reliably improves both the duration of life and the quality of life in patients with cirrhosis and end-stage liver disease. But not everyone is a candidate for liver transplantation, and the outcomes after liver transplantation are critically dependent on the patient's clinical condition at the time of transplantation, making optimal management of the patient prior to transplantation critical. 

This course will provide an overview of key management issues in the care of patients with cirrhosis and will cover:

• How to assess prognosis and determine the need to refer for transplantation, evaluation of the transplant recipient, and donors for living related transplantation. 
• Evaluation and management of portal hypertension and its complications such as variceal hemorrhage, ascites, and encephalopathy.
• Management of variceal hemorrhage.
• Evaluation and management of acute on chronic liver failure.
• Issues related to coagulopathy in cirrhosis and the use of blood products--an emerging important clinical issue where several traditional paradigms have recently been challenged. 
• Ascites, encephalopathy, and cardio-pulmonary disorders in patients with cirrhosis. 
• Hepatocellular cancer, treatment of underlying medical disorders, and miscellaneous topics such as the use of drugs, management of malnutrition, prevention of infections (other than spontaneous bacterial peritonitis), and end-of-life care-related issues.
• Individualizing the management strategy for hepatocellular cancer.

Goals and Objectives:

• Describe a multi-disciplinary approach to the management of patients with end-stage cirrhosis.
• Discuss the complications of cirrhosis and the approach taken for prevention, early detection, and management of such complications.
• Identify methods used to preserve hepatic synthetic function in subjects with cirrhosis.
• Identify common “non-hepatic” clinical problems that affect outcomes in patients with cirrhosis and the candidacy of patients for liver transplantation and the management of such conditions.
• Explain how to integrate clinical management decisions in subjects with cirrhosis with their ability to receive a liver transplant.