Hepatitis C: What happens in end-stage liver disease?

The hepatitis C virus slowly damages the liver — often over the course of several decades. As a result, end-stage complications of hepatitis C include liver failure and liver cancer. These conditions primarily occur in people who develop permanent scarring of the liver (cirrhosis) due to inflammation caused by the hepatitis.

About 20 percent of people with hepatitis C develop cirrhosis, usually within 10 to 30 years after infection.  Of those who have cirrhosis, about half progress to either liver failure or liver cancer.

Signs and symptoms of end-stage liver disease or liver cancer may include:

• Fatigue
• Persistent or recurring yellowing of your skin and eyes (jaundice)
• Loss of appetite
• Nausea and vomiting
• Fever
• Abdominal pain
• Abdominal swelling due to fluid accumulation (ascites)

In addition to liver failure or cancer, people with cirrhosis may also develop:

• Gastrointestinal bleeding due to enlarged veins (varices) in the esophagus
• Brain and nervous system damage due to the accumulation of toxins in the bloodstream (hepatic encephalopathy)

Once these complications occur, the disease tends to progress at a faster rate.

The best treatment for people with end-stage liver disease is liver transplantation. Though the number of people awaiting liver transplants far exceeds the number of donated organs, new developments in transplantation — including the donation of liver segments from living relatives and splitting one donated liver between two people — may make it possible for more people to receive transplants.