Liver Failure: Prognosis and Life Expectancy
Deaths from liver failure have been rising in the United States in the past 20 years, even as Americans in general are living longer. The death rate from cirrhosis of the liver grew by 17.5% between 2000 to 2015, while the average overall death rate fell by nearly 16% during that time period. Why? Experts point to a rise in liver diseases caused by obesity and excess alcohol consumption, especially among young people.
If you’ve been diagnosed with liver failure, keep in mind that your prognosis and life expectancy depend on many factors, such as the stage of your disease when you were diagnosed, your age and gender, and other health risks you may have. Your healthcare team can best answer questions about your individual prognosis. However, it’s also good to be informed about what to expect if you are living with liver failure.
Liver failure usually occurs when your liver has become seriously damaged due to cirrhosis (severe scarring of the liver). Liver scarring can be caused by illnesses such as hepatitis C, liver cancer, genetic conditions, autoimmune disorders, or conditions caused by poor diet and obesity or excessive alcohol use.
Cirrhosis can be present in one of two forms:
Compensated: Your liver has enough healthy tissue remaining to “compensate” for the loss of liver function from the scarring. You have no signs or symptoms related to cirrhosis, though you may have conditions affecting your stomach, esophagus or other organs. Life expectancy with this type of cirrhosis is about 9 to 12 years.
- Decompensated: Your liver is too scarred to compensate, so liver failure symptoms and complications are present. You may experience jaundice (a yellowing of your skin and the whites of your eyes), fluid in your abdomen, or a type of mental confusion that’s caused by liver failure, called hepatic encephalopathy. Life expectancy with this more severe form of cirrhosis is significantly lower than with compensated cirrhosis. Studies show one-year survival of 61%, two-year of 54%, and 45.4% at five years.
A Michigan study found that deaths due to cirrhosis increased by 65% from 1999 to 2016. Men had twice as many cirrhosis deaths as women, and four times as many liver cancer deaths. The greatest increase in cirrhosis deaths occurred in whites, Native Americans and Hispanics, while certain states saw particularly big spikes in cirrhosis and liver-cancer-related deaths, including Kentucky, New Mexico and Arkansas.
Cirrhosis complications have varying prognoses. For example, fluid in the abdomen, called ascites, is the most common and often the first complication of cirrhosis. After developing this, the estimated one-year survival (without transplant) is 50%.
Another type of liver condition that can develop is acute-on-chronic liver failure (ACLF). This occurs when someone with chronic liver failure develops multiple organ failure. A recent study found that about one-fourth of patients in the U.S. who are hospitalized for cirrhosis develop ACLF. Of these, 25% died within one month and 40% died within three months. Researchers said doctors need to recognize the seriousness of ACLF, so they can act quickly and aggressively to manage the condition.
Sometimes liver failure occurs suddenly, rather than after years of chronic illness, and is more often seen in younger people. The most common cause in the U.S. for acute liver failure is acetaminophen (Tylenol) overdose. Survival rates for acute liver failure have improved since 1998, according to a study that compared rates between 1998 and 2013. In 1998, 21-day patient survival was 59%, but jumped to 75% by 2013. Survival without a transplant nearly doubled, from 33% in 1998 to 61% in 2013.
While there are more than 100 different types of liver disease, the stages leading to liver failure are similar. The first stage often is inflammation of the liver in response to infection or injury. If caught and treated at this stage, the inflammation may go away. However, if inflammation continues, scar tissue forms (a process called fibrosis). The scarring often progresses, without symptoms, until it’s severe enough to be considered cirrhosis, at which point there is severe and often irreversible liver damage. Liver cancer also may occur in someone with cirrhosis.
In end-stage liver disease, your liver has lost all or most of its function. You likely feel nauseated, fatigued and may suffer from diarrhea and loss of appetite. You also may be jaundiced, bruise or bleed easily, and have painful swelling of your legs and abdomen.
As the disease worsens, symptoms may include:
Patients with liver failure often are considered for liver transplants, which can provide you with a functioning liver and a new lease on life—provided you can access an organ. (Unfortunately, about 17% of people on liver transplant lists die each year while waiting for organs.)
A scoring system to predict the survival of those with liver failure, called the model for end-stage liver disease (MELD), is used by liver transplant programs to determine your placement on transplant lists. MELD uses a scale from 4 to 60, with the higher score meaning your chance of survival is lower (and your need for a transplant is more urgent). A similar system for children under 12 is called the pediatric model for end-stage liver disease (PELD).
After a transplant, you likely will need to be on immune-suppressing anti-rejection drugs for the rest of your life, which can carry side effects such as diabetes, high blood pressure, and bone thinning. Also, depending on the reason your liver failed, your new liver may develop the same condition. This could initiate a new cycle of liver disease that could wind up with another transplant being needed. However, the good news is that about 75% of people who receive new livers live at least five years.
Your doctor is your best source of information about your individual prognosis. Talk to your treatment team about your disease progression and the best treatment options available to you.