Sr. Consultant, Liver Transplant, HPB & GI Surgery, Metro Heart Institute with Multispeciality, Faridabad
Part 9 of 10 in Diagnosis and Management of Liver Cirrhosis
Hepatitis B and C: Treatment and Family Precautions
June 16, 2024
Hepatitis B and C are both major causes of cirrhosis, but both now have effective treatments, along with clear precautions for family members and partners.
Treating hepatitis B and C
For hepatitis B, tenofovir and entecavir are effective drugs with low resistance and can practically control the virus, though not permanently cure it, since the virus can hide inside cells and reactivate years or decades later. For hepatitis C, directly-acting antivirals such as sofosbuvir and velpatasvir can effectively eliminate the virus from the body. Timely treatment of either virus can prevent cirrhosis from developing in the first place, though once cirrhosis has already developed, the liver will not return to normal even after the virus is eliminated.
Family and partner precautions for hepatitis B
Hepatitis B can theoretically transmit through blood exposure, such as a cut or shared blades, which is why the protocol is that if one family member is infected, the entire family should be vaccinated to build protective antibodies. Married couples are protected against transmission if the unaffected partner is adequately vaccinated, even while remaining sexually active.
This article is based on a Jivo Masterclass session conducted by Dr. Sandeep Jha, Consultant Liver Transplant, Manipal Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Sandeep Jha taught doctors across Africa on June 16, 2024.
FROM THE LIVE Q&A
Jivo Doctor Partner (name unclear from transcript)
What is the recipient's recovery timeline after living donor liver transplant?
Dr. Sandeep Jha
This depends on how sick the recipient was before surgery: a weaker, sicker patient takes longer to recover. The recipient typically stays in hospital for around 18 days, with discharges starting around day 12-13 and about 95% discharged by day 18. Complete recovery, meaning a return to normal muscle mass and full function, takes about two to three months. After 2-3 weeks of local follow-up near the hospital in India, the patient can return to their home country and continue follow-up from there.
Frequently Asked Questions
What is the risk to the donor's life during liver donation?▼
The overall global success rate is 99.5%, meaning about 1 in 200 donors could lose their life during the liver donation process. This is a rare occurrence that donors must understand during counselling as part of a major surgery, though outcomes have become safer with growing surgical experience.
What is the success rate for the recipient of a liver transplant?▼
The success rate for recipients is 90-95%, meaning even a very well-performed transplant carries a 5-10% chance the recipient will not survive, accounting for both surgical risk and post-transplant complications. The first 10 days of recovery are considered just as important as the surgery itself, since the body's adjustment to the new liver isn't always predictable.
Can hepatitis B spread through blood exposure or within a family, and what precautions should be taken?▼
Yes, theoretically, exposure to blood (such as from a cut, or sharing blades) can transmit hepatitis B. The protocol is that if one family member is infected, the whole family should be vaccinated to build protective antibodies against accidental exposure. Married couples are protected against transmission even in a sexual relationship if the unaffected partner is adequately vaccinated.
How is non-alcoholic fatty liver disease managed, including diet?▼
The first step is to identify and control all metabolic risk factors: obesity, diabetes, elevated cholesterol and triglycerides, and hypothyroidism. Once these are controlled, a low-calorie (under 2,000 kilocalories a day), low-fat, high-protein diet combined with exercise is recommended, with no single specific food item singled out. Medication is added if liver function tests remain elevated despite these changes.
Are any supplements needed for a healthy liver?▼
No, absolutely not. You don't require any supplements for a healthy liver. Maintain your weight, control diabetes, avoid gaining weight, avoid alcohol, get regular checkups (about once a year), exercise, and keep your body mass index under 25. Get checked for hepatitis B and C, and start treatment if there's a problem. A healthy lifestyle is what takes care of the liver, not supplements.
Can hepatitis B and C be cured?▼
Hepatitis C can be effectively eliminated with directly-acting antivirals. Hepatitis B can be very effectively controlled with drugs like tenofovir and entecavir, but not permanently cured, since the virus can reactivate later.
What precautions should a hepatitis B patient's family take?▼
The whole family should be vaccinated against hepatitis B to build protective antibodies; a vaccinated spouse is protected even in a sexual relationship with an infected partner.
In This Series: Diagnosis and Management of Liver Cirrhosis
- 1.Liver Cirrhosis
- 2.What Causes Liver Cirrhosis: Hepatitis, Alcohol and NAFLD
- 3.Diagnosing Cirrhosis Early: Fibroscan Before Symptoms Appear
- 4.MELD and Child-Pugh Scores: Grading Cirrhosis and Timing a Transplant
- 5.Decompensated Cirrhosis: Ascites, Encephalopathy and Liver Failure
- 6.Living Donor vs Deceased Donor Liver Transplant
- 7.Living Liver Donor Safety and Evaluation
- 8.Liver Transplant Recovery: Donor and Recipient Timelines
- 9.Hepatitis B and C: Treatment and Family Precautions
- 10.NAFLD and Metabolic Risk Factors: Diet and Lifestyle Management