common causes of cirrhosis in the United States are alcoholic liver disease and chronic viral hepatitis. Other causes of cirrhosis are shown in Table 1. The pathogenesis of fibrosis is complex and largely unknown, but central to the process is inflammation and subsequent repair. Local and distal inflammatory cells are recruited, and tissue fibroblasts (mainly hepatic stellate cells) are activated into extracellular-matrix-secreting myofibroblasts. 2 This process leads to disruption of normal liver architecture and interferes with hepatic blood flow, further leading to impairments in liver synthetic and metabolic functions as well as portal hypertension. Cirrhosis represents a clinical spectrum, ranging from asymptomatic liver disease to hepatic decompensation. Manifestations of hepatic decompensation include variceal bleeding, ascites, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, portopulmonary hypertension, and hepatocellular carcinoma. In hepatitis C, for instance, the 5-year survival rate is 91% for patients with compensated cirrhosis versus 50% for those with decompensated cirrhosis. 3