Nonalcoholic Fatty Liver Disease: Treatment, Procedure, Cost and Side Effects

Non-alcoholic fatty liver disease is also known as NAFLD.

Non-alcoholic fatty liver disease is a disease which is caused due to the deposits of fat in the liver for reasons other than alcohol consumption. Non-alcoholic steatohepatitis (NASH) is the most extreme form of NAFLD. NAFLD is the most common liver disease in the developed countries. This may be caused due to the excessive drinking of soft drinks which has high levels of fructose present in them. Drinking a lot of soft drinks can deposit fat in the liver due to the fructose content present in the drinks. This can also be caused due to genetic variations, and is seen very commonly in the United States. There are other causes to this disease and they include Starvation, Intravenous nutrition, Lipodystrophy and Drugs such as corticosteroids, tamoxifen etc.

There are no symptoms for this disease unless it has reached the advanced level, in which case it exhibits excessive bleeding, jaundice, gastrointestinal bleeding, mental changes and liver cancer. Since fatty liver generally does not cause symptoms or signs, and any symptoms and signs are more likely to be due to the accompanying diseases such as obesity, diabetes, vascular disease, etc. Treatment for NAFLD includes lifestyle changes and liver transplantation.

NAFLD is usually first suspected in a person who is found to have elevations in liver tests that are included in routine blood test panels, such as alanine aminotransferase (ALT) or aspartate aminotransferase (AST). When further evaluation shows no apparent reason for liver disease (such as medications, viral hepatitis, or excessive use of alcohol) and when x rays or imaging studies of the liver show fat, NAFLD is suspected. The only means of proving a diagnosis of NAFLD and separating it from simple fatty liver is a liver biopsy. For a liver biopsy, a needle is inserted through the skin to remove a small piece of the liver. The treatment includes changes in food habits and loss of weight. It does not take large amounts of weight loss to result in a decrease in liver fat. A less than 10% decrease in weight may be enough. If that does not work, a liver transplant is needed. This process is done when there are lot of complications in the liver. Normally doctors try treating the complications as and when they arise but another alternate Is liver transplant.

To have a liver transplant one needs to go through a check-up which takes around 5 days. This check-up includes a liver specialist who tests the condition of the liver and the general health in order to know if the body and the liver allow the transplantation. The liver specialists might ask for your drinking history, how this disease is affecting your life etc, which would help them decide if a transplant is a good decision or not. The specialists might want you to take several tests such as blood tests, endoscopy, x-rays and ECG. After all these tests, the doctors will decide if a transplant will be a success or not, if it is projected to be a success then they will proceed with a transplant if not then the doctors will ask you to come for regular check ups and give some medications to change the body condition for a transplant. There is no age restriction for liver transplantation, however, 70 years has been the maximum so for.

Anyone with NAFL is eligible for treatment. Patients generally feel well in the early stages and only begin to have symptoms—such as fatigue, weight loss, and weakness—once the disease is more advanced or cirrhosis develops.

Pregnant women and people with a history of heart disease may not be eligible for transplants, depending on their health.

The most common side effects of a liver transplant aren’t from the surgery, but from the anti-rejection medication patients must take for the rest of their lives, such as cyclosporine, tacrolimus, sirolimus, prednisone, azathioprine and mycophenolate mofetil. The immune system will sense that a transplanted organ is a foreign object and will attack it. Anti-rejection medication tricks the immune system into accepting the transplanted organ but, in doing so, lowers the body’s resistance to infection and certain types of cancer. The lifelong regimen of medication will be constantly monitored and adjusted to maintain a balance between preventing rejection and avoiding infection.

After the surgery the patient needs to visit the hospital regularly to get check-ups and tests done. At home the patients surrounding should be cleaned with disinfectants and the accommodation should be close to the hospital in case of emergency. Patients are advised to walk and not use a wheel chair. The number of visitors should be restricted and also avoid contact with any animals or birds. For the first 3 months, patients are advised to wear a mask and avoid crowded places like malls, cinemas, restaurants, department stores, etc. After this, patients can resume their regular social calendars. The patient is advised to eat food which is cooked hygienically and drink boiled/filtered water. Patients are requested to eat a lot of fruits and vegetables.

It takes around 3-4 months for the patient to recover and start a routine life, provided proper care has been given to the patient and no complication arises.

The cost of liver transplantation varies from 15lakhs -20 lakhs in India.

A person after liver transplant can survive for another 15 to 20 years provided they were no other complications raised during the recovery time.