Dr. Rajiv Lochan Lead ConsultantManipal Hospital Old Airport Road, Yeshwanthpur & Sarjapur

Liver disease can be caused by numerous genetic and developmental problems with the liver which can lead to liver diseases. In children, biliary atresia, a condition where the bile ducts in the liver do not develop properly, is a common cause of liver problems. This leads to small babies to get jaundice just immediately after birth. Fortunately, early intervention through a Kasai operation in the first few days or weeks following their birth can prevent further damage in many cases.

There are also various metabolic or genetic single-gene mutation disorders that can cause liver children in children. A hereditary cause of liver disease among children is Wilson’s disease which occurs due to mutation in a single gene, leading to abnormal or low levels of protein called ceruloplasmin. This leads to accumulation of copper in the body which can also damage the brain in some children. Another important genetic disease that can cause liver disease among children is called hemochromatosis, which occurs in the neonatal period.

Amongst adults and teenage children, non-alcoholic fatty liver disease (NAFLD) is becoming a growing problem worldwide, including in India. NAFLD is often related to obesity and can lead to more serious liver problems such as fibrosis, cirrhosis, and cancer. As far as adults are concerned, hepatitis B & C, alcohol, and intake of various other types of supplements leading to liver disease are common in India. Another aspect is autoimmune-related liver disease. There is some hereditary predisposition to autoimmune hepatitis where genes are not identified, but it occurs in clusters in families.

Liver cancer can also occur in individuals with liver problems, including those with cirrhosis and fatty liver. Sometimes, in the absence of cirrhosis, liver cancer can occur due to the spread of cancer from another part of the body to the liver. In fact, this is a very common cause of liver cancer. All these tumors need to be seen by specialists to achieve optimal outcomes because there are newer forms of treatment available that can be delivered only by a specialist liver team.

There are significant advancements over years in liver surgery which is the definitive form of treatment for most liver tumors. Advanced liver surgery techniques, often combined with other treatments such as radioembolization or chemoembolization, or percutaneous ablation of liver tumors can provide effective treatment with significantly extended survival for liver neoplasms. Even though the surgery is highly complex, there have been significant developments in the form of surgical instrumentation, better perioperative care, the use of robotic and laparoscopic techniques, techniques to increase the remnant liver and assess the liver, and imaging techniques which leads to better outcomes. Manipal Hospital has one of the largest and most experienced liver teams in India where complex operations are performed on a regular basis using the latest technology.

Liver transplantation is the ultimate solution for end-stage liver disease, liver cancer, like hepatocellular carcinoma (HCC), and some metastatic cancers. Liver transplantation for HCC has changed the paradigm and outcome for patients. It is able to afford more than 70% survival for more than five years, making it one of the best treatments for upper GI cancers. Therefore, transplant oncology which HPB and liver transplant surgeons deliver as a part of a multidisciplinary team is one of the newest modes of treatment which has changed the outlook for these patients.