Screening for Fatty Liver: Advice from a Transplant Surgeon
Until recently, cirrhosis and other late-stage liver disease due to hepatitis C was the leading reason for liver transplantation in the U.S. Now, with direct-acting antivirals, about 98% of patients infected with hepatitis C can be cured. Given the epidemic in cardiometabolic disorders, a different population is appearing most often on liver transplantation waiting lists: patients with nonalcoholic fatty liver disease.
“Middle-aged adults who have conditions such as obesity or Type 2 diabetes have a high incidence of fatty liver disease, even if they are otherwise relatively healthy,” says Kenneth Andreoni, M.D., an associate professor and chief of the division of transplantation surgery at the University of Florida College of Medicine. “Screening is important. After any abnormality on routine liver function tests, patients should follow up with either a referral to hepatology or a liver ultrasound looking for fatty liver disease.”
Liver disease in patients with cardiometabolic disease, compared with patients who have hepatitis C, is relatively silent, Andreoni cautions. “Physicians may think, ‘This patient doesn’t have hepatitis C or hepatitis B, just a slight abnormality. It is probably OK.’ However, there is still a need for screening.”
This population tends to be older when they present with end-stage liver disease, Andreoni explains. By then, their cases are more complex and they are more difficult to treat. “Given the pattern we are now seeing, when patients with metabolic issues have liver function test abnormalities, it should be seen as a trigger for screening for fatty liver disease. They may need to be managed more aggressively for their metabolic syndrome.”