SC Connecticut News

End-stage liver disease is the irreversible failure of the liver, leading to damage to other organs and eventual death. It usually results from cirrhosis, a condition occurring when chronic liver problems like alcohol-related liver disease, hepatitis C, hepatitis B, or metabolic dysfunction-associated fatty liver disease progress to their final stage of fibrosis. Cirrhosis has no specific treatment, but addressing the underlying cause can slow its progression.

Patients with cirrhosis can remain stable for 10 to 15 years or more; however, cirrhosis is unpredictable. Continued alcohol consumption, infections, or other factors can cause critical worsening, necessitating hospitalization or intensive care. Complications such as ascites, variceal bleeding, encephalopathy, or liver cancer can reduce survival to less than two years. While some patients may qualify for a transplant, others do not have this option.

In late 2023, Yale received a generous gift to establish a pilot program providing behavioral health care for patients with end-stage liver disease who are ineligible for transplant.

“There is a lot of emotional complexity that comes along with a cirrhosis diagnosis, and our patients need more than just symptom management,” said Joseph Lim, MD. “This pilot program will help us provide sobriety support, mental health care, and other behavioral health services to support the emotional and psychosocial needs of our patients.”

Each patient in the program has unique needs; however, common concerns include care for alcohol use disorder immediately after hospital discharge to prevent relapse.

“We use evidence-based relapse prevention strategies to help patients think through the week ahead and identify situations or triggers where they may be tempted to drink," says Kelly DeMartini, PhD. "Then we work together to build skills so they can plan ahead rather than just white-knuckling it."

Other patients diagnosed with cirrhosis years ago may now face complications requiring support to manage stress and unpredictability. Anxiety and depression often accompany chronic illnesses like cirrhosis. For those without transplantation options, psychological care helps cope with terminal diagnoses.

“Many of our patients are dealing with multiple stressors simultaneously,” says DeMartini. “We talk about managing health anxiety and depression associated with physical limitations and comorbid conditions like alcohol use disorder.”

“This program is revolutionary,” said Lamia Haque, MD. “There aren’t many places in the country where this kind of care is co-located. Our patients need more than just treatment for their end-stage medical complications; they also need care addressing factors leading to those complications.”

The new behavioral health pilot program is part of Yale's Liver Home initiative directed by Simona Jakab, MD. The Liver Home focuses on multidisciplinary outpatient care for individuals with advanced liver disease who are not eligible for organ transplants.

“Our vision is to truly provide wraparound integrated care," said Jakab.

To advance this goal, the team recently added a social worker to identify life needs such as financial assistance and housing support.

“We are trying to take a holistic look at each patient,” Jakab said.

Yale plans to expand the program further by helping families and caregivers through education about cirrhosis and providing home-care support. They are also collecting clinical and patient-reported outcomes to measure success and make improvements.

“Hepatologists are eternally optimistic,” said Jakab. “With the right care and support, our patients may actually reverse their disease or at least feel better.”

Since forming one of the nation’s first sections of hepatology over 75 years ago followed by gastroenterology nearly 70 years ago, Yale School of Medicine’s Section of Digestive Diseases has had an enduring impact on research and clinical care in gastrointestinal and liver disorders.