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Review
. 2021 Oct 9;398(10308):1359-1376.
doi: 10.1016/S0140-6736(21)01374-X. Epub 2021 Sep 17.

Liver cirrhosis

Pere Ginès  1 , Aleksander Krag  2 , Juan G Abraldes  3 , Elsa Solà  4 , Núria Fabrellas  5 , Patrick S Kamath  6
Affiliations
Review

Liver cirrhosis

Pere Ginès et al. Lancet. .

Abstract

Cirrhosis is widely prevalent worldwide and can be a consequence of different causes, such as obesity, non-alcoholic fatty liver disease, high alcohol consumption, hepatitis B or C infection, autoimmune diseases, cholestatic diseases, and iron or copper overload. Cirrhosis develops after a long period of inflammation that results in replacement of the healthy liver parenchyma with fibrotic tissue and regenerative nodules, leading to portal hypertension. The disease evolves from an asymptomatic phase (compensated cirrhosis) to a symptomatic phase (decompensated cirrhosis), the complications of which often result in hospitalisation, impaired quality of life, and high mortality. Progressive portal hypertension, systemic inflammation, and liver failure drive disease outcomes. The management of liver cirrhosis is centred on the treatment of the causes and complications, and liver transplantation can be required in some cases. In this Seminar, we discuss the disease burden, pathophysiology, and recommendations for the diagnosis and management of cirrhosis and its complications. Future challenges include better screening for early fibrosis or cirrhosis, early identification and reversal of causative factors, and prevention of complications.

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Conflict of interest statement

Declaration of interests PG reports research funding from Gilead Sciences, Mallinckrodt Pharmaceuticals, and Grifols; and participation in advisory boards for Gilead Sciences, Grifols, Mallinckrodt, Novartis, Martin Pharmaceuticals, and Ferring. AK is a speaker and advisory board member for Norgine and Siemens. JGA is a consultant for Gilead Sciences, Intercept, Genfit, Lupin, Inventiva, and Boehringer Ingelheim; and reports grant support from Gilead Sciences and speaker fees from Lupin. NF participated in advisory boards for Intercept. PSK is an advisory board member of Sequana. ES declares no competing interests.

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