Cirrhosis is often described as scar tissue, but cirrhosis is more than just scar tissue. The term cirrhosis is an anatomic description of the liver. It is defined as fibrosis (scarring) plus nodule formation (regeneration). Fibrosis alone does not qualify as cirrhosis. Fibrosis, like all scarring, basically never goes away. Thus cirrhosis is a pattern, not a disease or a specific phenomenon.

Cirrhosis can happen after any disease that causes liver cell death. Exactly why the regenerating nodules are not able to replace the function of the liver is not clear, although it may be the scarring itself that prevents recovery. We do know that if part of a normal liver is removed, the remaining liver will grow back to just the right size and function normally. This remarkable ability is not understood. Other organs like the kidneys, heart, and lungs are not able to regenerate. They can hypertrophy, (cells get larger) but they do not have cellular division that results in significant "regrowth" (more cells) like the liver does. This regrowth is what happens when a living donor gives part of their liver to be transplanted.

Two problems happen in patients with cirrhosis -- liver failure and portal hypertension. The liver failure causes fatigue, jaundice (yellow skin), and encephalopathy (a state of confusion that progresses to coma). The portal hypertension causes bleeding and ascites (fluid accumulation in the abdomen). These things happen in many forms of liver disease, not just in cirrhosis.

The scarring never goes away, but the liver has "reserve," meaning it can do all the body requires even though it is not working at 100 percent. The people that have long-standing (months to years) liver disease and develop the complications of cirrhosis that I mentioned will not, in general, recover. Some people can get a more sudden, "acute" form of liver failure (over days to weeks) and develop these complications, but these people do have the potential to recover on their own in some circumstances.

Jeffery Punch, MD

Dr. Punch is a transplant surgeon at the University of Michigan and member of the C.L.A.S.S. Scientific Advisory Committee