AASLD Practice Guidance: Palliative care and symptom‐based management in decompensated cirrhosis

Rogal, Shari S.; Hansen, Lissi; Patel, Arpan; Ufere, Nneka N.; Woodrell, Christopher D.; Kanwal, Fasiha

doi:10.1002/hep.32378

Cited by 103 publications

(135 citation statements)

References 346 publications

(583 reference statements)

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“…Consistent with recently published national and American guidance,16 46 LTADs cannot be regarded as standard of care in advanced cirrhosis, pending results of the definitive trial. The decision for LTAD insertion should therefore be made on a case-by-case basis at a multidisciplinary meeting where suitability for transplantation or TIPS should also be discussed.…”

Section: Guidance For the Management Of Patients Requiring Ltadsmentioning

confidence: 75%

Palliative long-term abdominal drains for the management of refractory ascites due to cirrhosis: a consensus document

Macken

Corrigan

Prentice

et al. 2022

Frontline Gastroenterol

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Palliative care remains suboptimal in advanced cirrhosis, in part relating to a lack of evidence-based interventions. Ascites remains the most common cirrhosis complication resulting in hospitalisation. Many patients with refractory ascites are not candidates for liver transplantation or transjugular intrahepatic portosystemic shunt, and therefore, require recurrent palliative large volume paracentesis in hospital. We review the available evidence on use of palliative long-term abdominal drains in cirrhosis. Pending results of a national trial (REDUCe 2) and consistent with recently published national and American guidance, long-term abdominal drains cannot be regarded as standard of care in advanced cirrhosis. They should instead be considered only on a case-by-case basis, pending definitive evidence. This manuscript provides consensus to help standardise use of long-term abdominal drains in cirrhosis including patient selection and community management. Our ultimate aim remains to improve palliative care for this under researched and vulnerable cohort.

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Section: Guidance For the Management Of Patients Requiring Ltadsmentioning

confidence: 75%

Palliative long-term abdominal drains for the management of refractory ascites due to cirrhosis: a consensus document

Macken

Corrigan

Prentice

et al. 2022

Frontline Gastroenterol

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“…In this case, the situation was even more challenging because this was a new diagnosis of cirrhosis and the patient himself was obtunded. The ICU, hepatology team, and family would benefit from guidance from the palliative care service if available, especially using the NACSELD-ACLF score, which is associated with futility (16–18). This is because liver transplant candidacy depends on multiple factors.…”

Section: Casementioning

confidence: 99%

“…The ICU, hepatology team, and family would benefit from guidance from the palliative care service if available, especially using the NACSELD-ACLF score, which is associated with futility (16)(17)(18). This is because liver transplant candidacy depends on multiple factors.…”

mentioning

confidence: 99%

Acute-on-Chronic Liver Failure

et al. 2022

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“…Despite great improvements in the management of patients with advanced cirrhosis and decompensation based on large randomised controlled trials with a huge body of published evidence,3–5 many of our liver disease patients will still die, and, within the field of palliative care there is only (currently) a weak evidence base for interventions that help. This is starting to be addressed but it is notable that the recent AASLD palliative care practice document describes itself as guidance rather than guidelines given the lack of randomised control evidence to inform them 6. Most patients who die of liver disease receive palliative care very late in their illness (if at all) and often only after exhaustion of curative options.…”

Section: Introductionmentioning

confidence: 99%

“…However, interest in palliative and supportive care for patients liver disease is growing with increasing numbers of reviews and references in practice guidelines 6–9. There is a growing body of high-quality clinical studies and now a number of randomised controlled trials,10–13 looking at interventions designed to help those at the end stage of their liver disease.…”

Section: Introductionmentioning

confidence: 99%

Symptom control in advanced chronic liver disease: integrating anticipatory palliative and supportive care

Wright

Woodland

Hudson

2022

Frontline Gastroenterol

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The number of patients coming to hospital with liver disease is increasing. There was a worrying trend before the pandemic, and this has intensified. Despite improvements in the management of patients with advanced cirrhosis many patients will die within 6–12 months of first presentation, and, despite this, the field of palliative and supportive care in liver disease is still in its infancy. This is a narrative review. Evidence is often thin in this field. Where it exists it is cited, but much of the commentary here is based on the authors own experience and readers are free to consider it and debate it. Most patients who die of liver disease receive palliative care very late in their illness (if at all). There are many barriers to supportive and palliative care in liver disease which are discussed. Symptom control is often poor because of these barriers. Before symptomatic control can be established, patients in need of it must to be identified and conversations had about the severity of their situation and what their wishes would be. Interest in palliative and supportive care for patients liver disease is growing as is the number of hepatologists and palliative care clinicians within the UK with an interest. It is important that this enthusiasm and interest can be rolled out and scaled up across the UK so that all patients, wherever they are, can benefit. The aims of these articles are first to highlight and bring into focus the unmet need for palliative and supportive care in liver disease and second to provide suggestions for its integration into liver services. Ask yourself the question: where would I start in my hospital to help these patients?

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AASLD Practice Guidance: Palliative care and symptom‐based management in decompensated cirrhosis

Cited by 103 publications

References 346 publications

Palliative long-term abdominal drains for the management of refractory ascites due to cirrhosis: a consensus document

Palliative long-term abdominal drains for the management of refractory ascites due to cirrhosis: a consensus document

Acute-on-Chronic Liver Failure

Symptom control in advanced chronic liver disease: integrating anticipatory palliative and supportive care

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