World Hepatitis Day raises awareness about the disease and helps in finding ways to prevent ways to reduce damage to liver.
Dr. Arvinder Soin, Chairman and Chief Surgeon, Institute of Liver Transplantation and Regenerative Medicine, Medanta, Gurugram, speaks about wide range of issues including the consumption of alcohol, treatment options and ways to lead a health life.
Excerpts:
How has the demography affected by liver failure changed over the years? What are the contributory factors?
There are significant shifts in the reasons for rising liver failure and liver cancer leading to the need for transplants. Approximately 10-12 years ago, hepatitis B and hepatitis C accounted for about 30-40% of the cases, while alcoholic liver disease was around 20%, and non-alcoholic fatty liver disease constituted 10-15% of the cases. Other causes made up the remaining 20-25%.
Now, the most common reasons for liver failure and liver cancer are non-alcoholic fatty liver disease, accounting for about 35%, followed by alcoholic liver disease at 30%. Hepatitis B has reduced to less than 5%, and hepatitis C is now around 10-12%. In the past, hepatitis B and C were the primary causes of liver failure, but now they rank as the third and fourth causes. The concerning trend is the rise of non-alcoholic or metabolic liver disease, which may not be associated with alcohol consumption. This condition affects people with uncontrolled diabetes, obesity, bad lipid profiles, poor lifestyle choices, and genetic predisposition. Currently, it accounts for nearly 35 to 40% of liver failure cases in India and worldwide.
Additionally, changes in lifestyle factors, including dietary choices, lack of physical activity, and unhealthy habits, has contributed significantly to the rise in non-alcoholic fatty liver disease. Rise in alcohol consumption, especially among the younger population, has also led to an increase in alcoholic liver disease cases.
What are the new age groups which are now showing liver diseases- groups which would have been very rare in the earlier years of your practice?
In the past, people with chronic alcoholism would require a liver transplant after being alcoholics for 10, 15, or even 25 years; typically between the ages of 40 and 60. However, in recent years, there has been a notable increase in such cases among younger individuals, particularly in the age range of 20 to 40 years. This age group is affected by alcoholic liver disease more frequently than it was just a decade ago. In 2023, compared to 2010, there are far more cases of 25 and 30-year-olds suffering from liver failure due to alcohol consumption.
What is the success rates of liver transplants in India and what are the other treatment options available?
Besides liver transplant, there are several treatment options available depending on the stage of liver disease. For early liver disease, such as alcoholic hepatitis or non-alcoholic steatohepatitis (NASH), lifestyle changes and medical management can lead to significant improvement. For instance- controlling diabetes, maintaining a balanced diet, and managing lipid levels can reverse liver damage by 50-70%. Viral infections like hepatitis B and C can be treated with medications in the early stages, avoiding the need for immediate transplants. However, if the disease progresses to cirrhosis (extensive liver damage), transplantation becomes necessary. Liver transplant is now a highly successful procedure in India. Over the last two decades, the success rates have increased significantly. At Medanta, among children, the success rate is around 98%; and among adults, it is about 97%. With these high success rates, liver transplantation has become a viable and effective treatment option for end-stage liver disease and liver cancer.
You mentioned various lifestyle factors contributing to liver diseases. Does the change in climate also have any significant impact?
While changes in climate and weather may not directly influence the liver, environmental pollution can have an impact. For example, water pollution can lead to infections like hepatitis A or E, which are acute viral infections. Additionally, air pollution has been associated with fatty liver disease and an increased risk of liver cancer. However, the major risk factors for liver diseases, as previously mentioned, are lifestyle-related, such as alcohol consumption, obesity, and unhealthy dietary choices. These factors have a more significant impact on liver health than climate or weather changes.
What exactly does moderate consumption of alcohol mean?
I firmly believe that no alcohol consumption is best for liver health. Any amount of alcohol can be damaging to the liver and other organs. However, to provide some context, moderate alcohol consumption is generally defined as no more than 10 units of alcohol per week for males and no more than seven units per week for females. One unit of alcohol is equivalent to 350 ml of beer, 150 ml of wine, or 30 to 45 ml of vodka or whiskey. Nevertheless, even moderate alcohol consumption can be harmful, especially for individuals with other risk factors such as diabetes or liver disease.
How does one go about having a liver transplant especially in terms of getting a donor?
There are two types of liver transplants: living donor transplant and deceased donor transplant. In a living donor transplant, a family member of the patient donates a portion of their liver, which is then transplanted into the patient. The donor's liver will regenerate to normal size within a few months, as will the transplanted portion in the patient. This is completely safe for the donor who will live a normal quality and length of life after donation. Furthermore, now we perform this surgery via the scarless robotic technique, so the recovery and cosmetic result is excellent.
For deceased donor transplants; the organ comes from a brain-dead individual whose family has agreed to donate their loved one's organs. Patients in need of liver transplants are registered on the NOTO (National Organ and Tissue Transplantation Organization) website. There is a national waiting list, and patients must wait for a suitable deceased donor match. The waiting period can range from six months to 18 months.
How can non-alcoholics remain vigilant towards liver health?
If you have any risk factors for liver disease, such as diabetes, obesity, or bad lipid profiles, it is essential to be vigilant and get regular liver check-ups. Individuals with known cases of hepatitis B or C should also undergo regular screenings. The screening tests include liver function tests (LFT), ultrasounds of the abdomen, and FibroScan. Additionally, AFP (alpha-fetoprotein) screening can be done for liver cancer detection. If any abnormality is detected, further evaluations and tests may be required to ensure timely treatment and prevent the progression of liver disease.
What about liver cancer?
There are two unique aspects of liver cancer. First, it is almost always a consequence of pre-existing liver diseases such as cirrhosis. People with chronic liver disease or cirrhosis have a 20 to 25% chance of developing liver cancer within 10 years of diagnosis. Therefore, regular liver cancer screening with AFP and ultrasound is essential for high-risk individuals. Detecting liver cancer at an early stage improves the chances of successful treatment and better outcomes.
Second, is a fact not many know. Liver cancer can be cured in its first three of the four stages (as long as it hasn’t spread elsewhere in the body outside of the liver) with a liver transplant.
