Question 1

Are any supplements needed for a healthy liver?

Dr. Sandeep Jha · Accepted Answer

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.

Question 2

What is refractory ascites and how is it managed?

Dr. Sandeep Jha · Accepted Answer

Regular ascites is managed with salt restriction, diuretic tablets and tapping. Refractory ascites is fluid that does not respond to salt restriction and maximum doses of diuretics, or that returns within a week of tapping, sometimes within two or three days. The patient will keep losing protein and grow weaker, with a high infection risk, so they should be referred for a liver transplant as soon as possible. There is no other long-term treatment. In the interim, keep tapping the patient at least twice a week and give albumin with each tap.

Question 3

Can hepatitis B be permanently cured with current drugs?

Dr. Sandeep Jha · Accepted Answer

Today's drugs are excellent compared to 10 years ago and can control the virus very effectively. However, they cannot permanently cure hepatitis B, because the virus hides inside cells and can reactivate even after years or decades.

Question 4

Do all patients with liver cirrhosis go on to develop features of decompensation?

Dr. Sandeep Jha · Accepted Answer

No, absolutely not. Not every cirrhosis patient decompensates: the data show that about 5% of all cirrhosis patients decompensate each year. If cirrhosis is diagnosed early and the risk factors are controlled (weight loss, diabetes control, control of hepatitis B and C), there is a very good chance the patient can live out his life with the same liver. But there is no tool to predict how long a given cirrhotic liver will last, which is why we put patients on surveillance with tests every six months. The moment those tests deteriorate or fluid starts to form in the abdomen, we know the liver is failing.

Question 5

How is the progression from fatty liver to cirrhosis diagnosed and managed?

Dr. Sandeep Jha · Accepted Answer

Steatohepatitis is the stage at which the liver is inflamed. The first step is to find out whether the patient has developed cirrhosis, and there are two ways to confirm that in an early patient: a fibroscan or a liver biopsy. If the patient is at the steatohepatitis stage with no fibrosis, controlling the risk factors will improve it and it can disappear completely, with medication as needed. If cirrhosis has developed, the patient has to be kept under regular follow-up, because there is no way of knowing when a cirrhotic liver will start to fail; we can only monitor it throughout.

Question 6

Is a liver biopsy necessary to diagnose cirrhosis?

Dr. Sandeep Jha · Accepted Answer

It is not necessary. A good fibroscan can diagnose early cirrhosis.

Question 7

What are the exam findings of cirrhosis, and when do they appear?

Dr. Sandeep Jha · Accepted Answer

On examination, jaundice, ascites, leg oedema, spider angiomas, palmar erythema and gynaecomastia are the telltale signs of cirrhosis. Unfortunately, these are only seen in advanced cirrhosis. Since the goal is to catch cirrhosis before complications develop, an ultrasound or fibroscan done proactively is the better approach for early diagnosis.

Question 8

What are the effective drugs for hepatitis B and C?

Dr. Sandeep Jha · Accepted Answer

For hepatitis B, tenofovir and entecavir are very effective drugs with low resistance levels that can practically control the virus. For hepatitis C, directly-acting agents such as sofosbuvir and velpatasvir are very effective and can practically eliminate the virus from the body.

Question 9

What is the donor's recovery timeline after living donor liver transplant?

Dr. Sandeep Jha · Accepted Answer

The donor is admitted for about seven days. By the third or fourth day, the donor is walking around, eating, and relatively pain-free, and is discharged by day six or seven. A follow-up OPD visit happens on day 10; if doing fine, the donor can return to their home country and resume office and light household work, with the only restriction being on lifting heavy weights.

Question 10

What is the recipient's recovery timeline after living donor liver transplant?

Dr. Sandeep Jha · Accepted Answer

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.

Question 11

What is the risk to the donor's life during liver donation?

Dr. Sandeep Jha · Accepted Answer

The overall global donor survival is about 99.5%, meaning about 1 in 200 donors could lose their life during the liver donation process, on global data that is now more than 10 years old. 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.

Question 12

What is the success rate for the recipient of a liver transplant?

Dr. Sandeep Jha · Accepted Answer

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.

Question 13

Can hepatitis B spread through blood exposure or within a family, and what precautions should be taken?

Dr. Sandeep Jha · Accepted Answer

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.

Question 14

How is non-alcoholic fatty liver disease managed, including diet?

Dr. Sandeep Jha · Accepted Answer

First look for and control all the metabolic risk factors: reduce weight in obesity, control diabetes, control elevated cholesterol and triglycerides, and treat hypothyroidism. Once those are controlled, if the problem is only obesity, the recommended diet is simply low-calorie, low-fat and high-protein. We put the patient on a strict diet chart of under 2,000 kilocalories in 24 hours, ask him to exercise and lose weight. If the liver function tests are elevated, we sometimes add medication. There is no particular food item we recommend; the broad guideline is calorie control and a low-carbohydrate, low-fat, high-protein diet.

Live Discussion with Dr. Sandeep Jha