Treatment

Treat the underlying condition

Screen for, recognize, and treat complications and decompensations

Alcohol

• Complete abstinence is recommended for patients with cirrhosis.

• Initiate treatment for alcohol disorder if present.

Typical drugs to avoid include:

• NSAIDs

• Opiates

• Benzodiazepines in hepatic encephalopathy

Stop nonessential medications.

Nonselective beta blockers (e.g., propranolol) may be indicated for prophylaxis of esophageal varices and to prevent variceal bleeding

Routine vaccinations: pneumococcal (PPSV23), hepatitis A, hepatitis B, influenza, SARS-CoV-2, and tetanus

Avoidance of raw seafood and unpasteurized dairy

Prophylactic antibiotics (e.g., after previous spontaneous bacterial peritonitis or GI bleeding)

A liver transplant is the only curative option in patients with cirrhosis.

Indications for liver transplant evaluation include:

• Occurrence of an index complication: i.e., ascites, hepatic encephalopathy, variceal hemorrhage

• Hepatocellular dysfunction resulting in a MELD score of ≥ 15