Palliative care for end-stage liver disease and acute on chronic liver failure: A systematic review

Core Tip

Core Tip: This systematic review addresses the underexplored utilization of palliative care (PC) in patients with end stage liver disease (ESLD) and acute on chronic liver failure (ACLF), a demographic traditionally underserved. ESLD and ACLF are characterized by grim prognoses, substantial care costs, explicit patient suffering, and elevated mortality rates. Despite liver transplantation (LT) being a curative option, accessibility remains severely limited due to barriers such as donor scarcity, financial constraints, and inadequate social support. Even among those eligible for transplantation, a significant majority of ESLD patients are referred late for PC, typically within their final couple of weeks of life. PC offers notable benefits, including amelioration of symptom burden, reduced depressive symptoms, lower readmission rates, and shorter hospital stays. However, optimal utilization of PC faces barriers such as the allure of transplants and misconceptions about PC. A comprehensive understanding of the pivotal role of PC in ESLD and ACLF treatment is crucial for all stakeholders, including healthcare providers, patients, and caregivers, to overcome these barriers. Future prospective randomized studies, irrespective of LT eligibility, are needed to strengthen the evidence supporting early integration of PC in the management of ESLD/ACLF patients.