• Pere Ginès, Aleksander Krag, Juan G Abraldes, Elsa Solà, Núria Fabrellas, and Patrick S Kamath.
• Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Institute of Biomedical Investigation August Pi I Sunyer, Barcelona, Spain; Hepatic and Digestive Diseases Biomedical Investigation Center, Madrid, Spain. Electronic address: pgines@clinic.cat.
• Lancet. 2021 Oct 9; 398 (10308): 1359-1376.

AbstractCirrhosis is widely prevalent worldwide and can be a consequence of different causes, such as obesity, non-alcoholic fatty liver disease, high alcohol consumption, hepatitis B or C infection, autoimmune diseases, cholestatic diseases, and iron or copper overload. Cirrhosis develops after a long period of inflammation that results in replacement of the healthy liver parenchyma with fibrotic tissue and regenerative nodules, leading to portal hypertension. The disease evolves from an asymptomatic phase (compensated cirrhosis) to a symptomatic phase (decompensated cirrhosis), the complications of which often result in hospitalisation, impaired quality of life, and high mortality. Progressive portal hypertension, systemic inflammation, and liver failure drive disease outcomes. The management of liver cirrhosis is centred on the treatment of the causes and complications, and liver transplantation can be required in some cases. In this Seminar, we discuss the disease burden, pathophysiology, and recommendations for the diagnosis and management of cirrhosis and its complications. Future challenges include better screening for early fibrosis or cirrhosis, early identification and reversal of causative factors, and prevention of complications.Copyright © 2021 Elsevier Ltd. All rights reserved.

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