Advanced Chronic Liver Disease and Cirrhosis


Advanced Chronic Liver Disease is the result of repeated damage to the liver over time, resulting in scar tissue (fibrosis) within the liver. This fibrosis can prevent the liver from working normally. There are many different causes of liver fibrosis, including autoimmune liver disease, metabolic liver disease, alcohol related liver disease, viral hepatitis and inherited disorders. 

Extensive liver fibrosis can result in cirrhosis. People with cirrhosis need regular careful monitoring to avoid complications. Complications include infections, clots in the veins supplying blood to the liver, liver cancer and swelling with excess fluid in the abdomen and on the legs. 

The Cirrhosis Service at Royal Free Hospital 

Here at the Royal Free Hospital, we have the expertise to diagnose, monitor and treat patients with cirrhosis as a result of a multitude of different liver diseases. 

We have a holistic approach to the management of our patients, working within a multidisciplinary team of doctors, specialist nurses, dieticians and alcohol liaison services to deliver patient-centred care. 

As one of the UK’s leading centres for treating liver disease, we also provide specialist support to hospitals across the region and transfer patients needing urgent specialist care to our hospital.  

Who should be referred? 

We welcome referrals from GPs and Community Services for patients with suspected Advanced Chronic liver disease of any cause.  

We also support and welcome referrals from surrounding hospitals referring patients with complications of cirrhosis, including: 

  • Diuretic resistant refractory ascites 
  • Refractory encephalopathy 
  • Portal/Splanchnic vein Thromboses 
  • Hepatocellular Carcinoma 
  • Refractory or recurrent gastrointestinal bleeding secondary to portal hypertension 
  • Recurrent hepatic hydrothorax 
  • Hepatopulmonary syndrome 
  • Hepatorenal syndrome 
  • ACLF – Acute on Chronic Liver Failure 
  • We provide access to a multitude of specialist services including: 
  • Assessment for liver transplantation 
  • Transjugular intrahepatic porto-systemic shunts (TIPS) 
  • Tunnelled peritoneal catheter insertion 
  • Liver Intensive Care 
  • Advanced care planning 
  • Alcohol Liaison Services 
  • Dietetics and Metabolic Disease management 

Information for Patients 

The British Liver Trust provides excellent information in chronic liver disease and cirrhosis. 

Contact details for referrers 

General Practice  

Please refer patients via NHS e-Referral. Please enclose results of any recent imaging and a full liver screen. 

Secondary Care Referrers 

For outpatient assessment, please email your referral letter to For urgent inpatient referrals, the liver unit always has an on call hepatology specialist registrar/fellow supported by a consultant available to discuss referrals. Please contact the Royal Free Hospital Switchboard and ask for the Hepatology SpR.