The liver is a vital organ. Transplantation alternatives exist for other organs, like dialysis for kidney failure or heart pumps for severe heart failure. But liver transplantation is only an option to overcome the complete loss of its function. In general, liver failure is not due to the liver’s cells not working right; it is the consequence of severe scarring, also known as cirrhosis. Cirrhosis prevents the liver’s cells from accessing the blood that it needs to clean and causes back pressure into the intestine’s blood flow.
When failure occurs, liver functions are progressively lost. Signs of liver failure include:
- jaundice (a yellow color to the skin and eyes)
- bruising and bleeding, and confusion
Potential causes for liver failure (from most to least common) include:
- Non-Alcoholic Fatty Liver Disease (NAFLD), also known as steatohepatitis
- Hepatitis C
- Hepatitis B
- Immune mediated liver disease like PSC, PBC and Autoimmune Hepatitis
- Storage diseases like hemochromatosis (Iron excess), Wilson Disease (copper excess) of Alpha-1 Antitrypsin Deficiency
- Other rare diseases and occasionally medications
The most common liver disease in Utah and U.S. is non-alcoholic fatty liver disease. Around 100 million people in the U.S. have a fatty liver. Before 1980, non-alcoholic fatty liver disease was rare. Of all transplantations in the 1980s, less than 5 percent (or around 200 cases per year) were for fatty liver disease. In 2019, non-alcoholic fatty liver disease is the most common reason a patient is seen in Intermountain liver clinics. Fatty liver disease is the most common reason for cirrhosis in Utah and the U.S., and it now accounts for 25 percent of all liver transplants (or around 1,600 transplants per year).
Unfortunately, in the next 20 years, approximately 1.5 million people will develop cirrhosis from fatty liver disease. Of those with a fatty liver, less than 10 percent (and some medical experts think less than 5 percent) have been identified. In the U.S., there are only 8,000 transplants per year. The waiting list for a liver transplant is long — 25 percent on the list die each year waiting for a new liver. This is a crisis set to engulf us. We must act now to identify at risk patients and prevent those with fatty liver from developing liver failure.
Fatty liver can occur in anyone. However, it is most often seen in those with risk factors. If you have more than one rick factor, you are at greater risk. Risk factors include:
- Obesity (meaning you are overweight)=
- Diabetes (generally Type 2 diabetes)
- High cholesterol or triglycerides
- Increased liver function tests of an unknown cause, also known as liver enzymes
- Family history of liver disease, liver failure, or liver cancer in family members who did not drink alcohol and they did not have hepatitis B of hepatitis C
Treatment and prevention options for fatty liver disease include:
- Dietary changes, in particular a Mediterranean Diet
- Brewed coffee
- Weight loss
However, when these prevention steps do not work, there are other approaches that can treat fatty liver, including certain medications and bariatric surgery. These are most effective if done early and are largely unhelpful or unable to be done once irreversible scarring (cirrhosis) has occurred.
If you have risk factors and have not had liver tests conducted by your doctor, ask to have your liver checked. Ask about your results and what they mean. It is important to remember that minor elevations in liver enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT) can represent significant disease occurring in your liver. To sort whether abnormal tests indicate liver disease, a liver biopsy is generally not required. Today we have new technologies like FibroScan (a five-minute test) or Magnetic Resonance Elastography (MRE). These tests are painless, risk free and can categorize whether there is liver trouble on your horizon.
Working through your family medicine physician, internal medicine physician, endocrinologist, or cardiologist is where these conversations should start. Remember Intermountain’s liver specialists are here to help. Intermountain is committed to helping people live the healthiest lives possible. An important way to achieve this is an institutional commitment to eliminating cirrhosis from fatty liver disease in the coming years.