On Tuesday evening, November 15, the Navigating the Medical System Lecture Series featured a virtual lecture on liver disease and liver transplant. Dr. Mel Breite, Founder and Director of the series, welcomed everyone.

The first speaker, Dr. Emily Schonfeld, hepatologist at Weil NY Presbyterian Cornell Medical Center, shared that the most common type of liver disease in the United States is fatty liver disease. Fat building up in the liver can cause scar tissue. This can happen with no symptoms.

Dr. Emily Schonfeld

She taught that the liver is located on the right side of the abdomen, under the ribs. Its color is red-brown, and it weighs around three or four pounds. It has two lobes – one on the right and one on the left. She explained that the function of the liver is to break down medication and to regulate the metabolism of cholesterol, sugar, and protein. It plays a role in blood clotting, and it is involved in the immune system. When people have chronic liver disease, their immune systems are not working as well as they should. The liver also is involved in bile drainage and glucose regulation. She related that the liver is important and there is no machine to replace it.

Dr. Schonfeld taught that often patients don’t know that they have liver disease. It is caught with elevated liver tests in blood or imaging of the liver. A person with liver disease is referred to a specialist. She then shared the five big causes of liver disease. These include the following: non-alcoholic fatty liver disease, alcohol, viral hepatitis, genetic disorder, and autoimmune disorders. She recommended that every adult over 18 should be tested for Hepatitis. There is medication for Hepatitis B and there is a cure for Hepatitis C.

She showed a slide of a liver with fatty liver disease. It has yellow deposits that accumulated in the liver. Over many years, liver disease can build up scar tissue. When there is a lot of scar tissue in the liver, it is called cirrhosis and that is end-stage liver disease.

Signs and symptoms of cirrhosis include yellow skin or eyes, a swelled stomach, swelled legs, bleeding, and confusion. This can lead to liver cancer. When the liver is not working normally, it can’t clear toxins in the body. This would be the reason for a possible liver transplant.

Overuse of alcohol can cause fat to build up in the liver. She then taught the risk factors, which include diabetes, metabolic syndrome malnutrition, genetic, medications, and alcohol. Rapid weight loss can cause fat to accumulate in the liver. Fatty liver disease is associated with heart attacks and strokes. Some medications can predispose a person to fatty liver disease. She mentioned Tamoxifen.

High fructose corn syrup increases the risk of fatty liver disease. Foods with high fructose corn syrup include sodas, ketchup, cookies, and processed foods.

Today, physicians can do more imaging and so they avoid doing as many biopsies as possible. The main treatment is diet, weight loss, and exercise. She recommends the Mediterranean Diet and fewer simple sugars. If necessary, bariatric surgery could help. There are clinical trials going on now to find a cure to fatty liver disease.

Next, Dr. Juan P. Rocca, who specializes in Transplant Surgery at Weill Cornell, shared information about liver transplants. He noted that liver cancer is the sixth most common cancer in the world. It is the third leading cause of cancer-related death. It is becoming more common due to habits in diet and alcohol. He traced the progression that leads to liver cancer. It is chronic inflammation, fibrosis, cirrhosis, and then cancer. If you have liver disease, he said that you should be screened for hepatocellular carcinoma at early stages. Screening can be done with ultrasound or CT scan. When liver surgery will not remove all the tumors present, then a liver transplant is a better option. He explained the various types of surgery and he also shared the pros and cons of liver transplant. It offers the best long- term effects. The cons include that there is a limited number of organ donors, and the patient has to take anti-rejection medication.

A transplant must occur within 8-to-12 hours after the donor’s liver is recovered. Liver donation is possible because it is the only organ that can regenerate itself.

The donated portion will fully regrow within four months and will ultimately regain full function.

The lecture concluded with a lively Q&A session. Everyone left well-informed about liver disease and liver transplants.

 By Susie Garber