**5. Does etiology of the liver disease appear to influence individual's HRQOL? Issues concerning Acute Liver Disease vs. Chronic Liver Disease**

Pretransplantation HRQOL scores are affected by the etiology of liver cirrhosis, therefore it is important the knowledge of the impact of a particular disease. Patients with hepatocellular and cholestatic etiologies have higher HRQOL scores than alcohol or viral hepatitis patients (Bianchi, 2003; Steel, 2007). Although the individual's perception of his/her state of health is crucial, different etiologies may identify some of the characteristics of the components of QOL in liver diseases (Krasnoff,2005). In general terms, younger and male people perceive a better QOL compared to older and women patients (Painter, 2001).

In early stages, liver disease patients show few or non-specific symptoms, therefore reporting insignificant effects on HRQOL. As the disease progresses to cirrhosis and complications arise (ascites, muscle cramps, fatigue etc.) individuals report noteworthy effects on HRQOL (Gutteling, 2006; Björnsson, 2009). In patients with advanced disease the etiology of the liver disease does not seem to influence patients' ratings. Although in earlier cases of chronic cholestatic liver disease significant pruritus and fatigue may have a significant impairment of HRQOL (Poupon, 2004). These symptoms that may also be observed in chronic hepatitis C may not be present in those with other forms of chronic liver disease such as chronic hepatitis B or iron overload (Lam, 2009).

We will explore the most important issues that have been developed in the last few years (Jay, 2009). Some determinants of HRQOL are derived from specific symptoms and concerns of liver diseases, but a generic HRQOL test is unable to measure them (Gutteling, 2007; Kotlyar, 2008). Examples of some specific problems observed in advanced liver disease are: sleep related problems, sleep pattern changes, stigma of liver disease, symptoms and effects of liver disease and their treatments (Holzner, 2001).
