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Advanced chronic liver disease (cirrhosis)

What we do

Advanced chronic liver disease (ACLD) includes advanced liver fibrosis and cirrhosis. It occurs when the amount of scar tissue (called fibrosis) builds up and affects the way the liver looks and functions. Fibrosis can be caused by many different liver diseases (for example metabolic liver disease, alcohol related liver disease, virus and autoimmune diseases).

People with ACLD are at risk of “decompensation”, where the liver is not capable of performing all of its normal functions.

The ACLD team provides the specialist input needed to diagnose and manage the symptoms of liver disease, working in continual partnership with your local gastroenterology or hepatology teams, GP and community services.

Our team will help you access specialist treatments for your liver disease when you need them.

We discuss all patients referred to the ACLD service in a multidisciplinary meeting.

Depending on the outcome of this meeting, we aim to see patients as soon as possible after referral. We then discuss with you, at your clinic appointment, options for management of your condition.

Common complications of ACLD we manage are:

  • ascites (fluid build-up in the abdomen)
  • encephalopathy (the effect of liver disease on brain function)
  • varices and bleeding (swollen veins in the gullet and stomach which can cause bleeding)
  • malnutrition (weight loss which is associated with advanced liver disease)

Patient information is also available from the British Liver Trust.

Preparing for your appointment

Your local hospital or GP will refer you to our service and will enclose in their referral to us all relevant recent blood tests and investigation results.

Please bring a copy of your current medications with you and any letters you have received from specialists you have seen in the past.

Please try and think of the main questions you would like answered when you come to your appointment and write them down before you come so we can answer them for you.


We are always trying to improve the care and the clinical outcomes of patients with ACLD. One way to do this is to use the most up-to-date medications or interventions in the setting of a clinical trial, and there are usual multiple trials running within the service. We will always try to invite you to take part in research that may be suitable for you. Taking part is completely voluntary.

Some of these studies are designed as ‘randomised controlled trials’ to evaluate whether a newer treatment is more effective, and these trials will often include a placebo or ‘dummy drug’ to compare to. If you decide to take part, we will always seek your permission first so that you and your family and carers have an opportunity to ask questions and have any concerns addressed by our research team. You will also be provided with written information.

We also carry out observational studies to better understand disease processes in our patients with ACLD, in order to improve diagnosis, identify new treatments and to find better ways of managing this condition. These studies involve the collection of samples including blood, saliva, urine or stool of patients with ACLD, and we will always aim to combine any study visits with your clinic appointments to make it as easy as possible for you to take part. If you are interested, please ask your clinical team.


Suite 9, Third Floor, Golden Jubilee Wing, King’s College Hospital, Denmark Hill, London, SE5 9RS

Contact Details

Patient information leaflets

TitleFile SizeLink
Advanced chronic liver disease (ACLD)824 KB
Avatrombopag (Doptelet®) treatment156 KB
Long term abdominal drain (LTAD): before the procedure174 KB
Lusutrombopag (Mulpleo®) treatment490 KB
Transjugular intrahepatic portosystemic shunt (TIPS)233 KB

Conditions we treat

The advanced chronic liver disease (ACLD) service provides specialist input in managing complications of liver disease and portal hypertension. It aims to optimise management of the underlying liver condition, treat liver disease where possible, improve quality of life and minimise unnecessary hospital admissions.

NICE guidelines suggest all patients with a model for end-stage liver disease score (MELD Score) of more than 12 should be referred to a hepatologist.

We encourage referral to our service for patients with the following complications of ACLD:

  • ascites
  • encephalopathy
  • hepatic hydrothorax
  • portal vein thrombus
  • refractory/recurrent portal hypertension related GI bleeding
  • other clinical concern in patients with ACLD

The ACLD service provides access to:

  • a multidisciplinary forum for discussion of patients with complex decompensated chronic liver disease
  • liver transplantation assessments
  • transjugular intrahepatic porto-systemic shunts (TIPS)
  • optimisation of nutritional status
  • alcohol liaison services
  • tunnelled peritoneal catheter (long-term ascitic drain) insertion
  • palliative care and advanced care planning

All patients referred are discussed at the ACLD multidisciplinary team meeting and then seen for a face to face appointment in our dedicated ACLD clinic.

What is required before referring a patient

Referrers should fill out the ACLD MDM referral form below with as much information as possible. It is also useful to inform the patient that they have been referred to King’s College Hospital, and that they should expect an appointment here within two to three weeks (depending on the ACLD MDM outcome).

It is important to send over any imaging taken locally, so it can be discussed at the Liver Radiology MDM for further clarification if needed.

Once the patient is discharged, it is the local team’s responsibility to ensure the patient has continuous care and to support them going forward.

Booking a patient at King’s

Routine Referrals

Tertiary referrers should refer via the ACLD MDM referral form below and email to [email protected]

GPs should refer via NHS e-Referral. Include the ACLD MDM referral form below and state that the referral is urgent.

Emergency Referrals

The liver unit always has an on-call specialist registrar, supported by a consultant, to accept urgent referrals requiring inpatient assessment or advice. To contact them, call the main switchboard on 020 3299 9000 and ask for the adult hepatology SpR or on-call adult hepatology consultant.

Referral forms

TitleFile SizeLink
Advanced Chronic Liver Disease MDM referral form268 KB

Key Clinical Staff

Name Role
Janet Carty Senior Clinical Nurse Specialist - Regional Co-ordinator
Dr Michelle Cheung Consultant
Dr Mark McPhail Liver Intensive Treatment Unit Consultant
Mr Alejandro Esquivel Morocho Advanced Chronic Liver Disease CNS
Dr Nicola Owen Consultant Hepatologist
Daniel Robles Ortiz Advanced Chronic Liver Disease CNS
Dr Vishal C Patel Advanced Chronic Liver Disease
Dr Wendy Prentice Consultant in Palliative Medicine
Prof Debbie Shawcross Professor of Hepatology & Chronic Liver Failure ACLD Team
Dr Charlotte Woodhouse Locum Consultant Hepatologist and General Physician