Complications of Cirrhosis

The field of liver diseases is experiencing an explosion of new knowledge in many different areas: the treatment of chronic hepatitis B and C infections, the application of new techniques of genomics and proteomics to the assessment of chronic liver diseases, the investigation of new treatments for nonalcoholic steatohepatitis, the pathogenesis and treatment of hepatocellular carcinoma, and the management of complications of cirrhosis, just to cite a few. The investigation of management of complications of cirrhosis has been fostered mainly by two factors. The first is that cirrhosis has become a very common disease, particularly as a result of persistent high alcohol intake in many countries, high frequency of chronic hepatitis B and C infection in populations from different areas of the world, and the new epidemics of nonalcoholic steatohepatitis. In fact, data from North America and Europe indicate that cirrhosis and its complications, including hepatocellular carcinoma, are among the leading causes of death in many countries. The second factor that has fostered the recent research on cirrhosis is the wide applicability and tremendous success of liver transplantation in patients with cirrhosis. Liver transplantation has become a standard therapeutic procedure in many countries for the treatment of patients with end-stage cirrhosis. The shortage of donors has stimulated the improvement of therapeutic measures to manage the complications of cirrhosis with the aim of keeping patients alive until a suitable donor is available. As a consequence, the treatment of complications of cirrhosis has advanced enormously in recent years.

For this reason, it was timely to devote an issue of Seminars in Liver Diseases to this topic. The current issue has been divided into eight review articles that cover almost the whole spectrum of complications of cirrhosis and are written by clinicians who are well-known experts in their respective areas. The articles are oriented clinically, but with essential scientific background, and are devoted for the most part to the clinical management of each condition. They represent a superb update on what it is necessary to know in 2008 for an accurate and optimal management of patients with advanced cirrhosis.