“Alcohol is the Main Cause of Liver Problems”: Dr. Akanand Singh, Liver Transplant Surgeon

Kathmandu – Dr. Akanand Singh is a senior liver transplant surgeon affiliated with KIST Medical College and Teaching Hospital in Gwarko, and also serves as a consultant general and hepatobiliary surgeon at Grande International Hospital. He has been instrumental in pioneering liver transplantation in Nepal. 
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In a recent conversation, Dr. Singh highlighted that approximately 80% of liver patients suffer due to alcohol consumption. He stated, "Hepatitis B and C can also cause liver issues. However, maintaining a proper diet helps. One must consume protein-rich foods. Once cirrhosis has occurred, alcohol must be strictly avoided."

Edited Excerpts from the Interview:

What types of liver problems are common, and when is liver surgery necessary?

Liver issues vary, but only a few cases require surgery. Many people misunderstand the term "fatty liver" when it's mentioned in ultrasound reports. If not managed early, fatty liver can progress to fibrosis or cirrhosis. Controlling liver cirrhosis is crucial, as its progression can lead to complete liver failure, necessitating a liver transplant.

Other liver diseases, such as tumors, may also require surgery. Early-stage liver problems often go unnoticed and are typically detected in advanced stages. Regular check-ups, including liver function tests and abdominal ultrasounds, are essential for early detection. Symptoms like jaundice, weakness, or abdominal fluid accumulation may indicate late-stage liver disease.

How can one identify the early symptoms of liver cirrhosis?

Liver cirrhosis involves the hardening of the liver. Initially, fatty liver leads to slight hardness, progressing to significant stiffness in cirrhosis. In Nepal, the primary cause of cirrhosis is alcohol consumption. However, dietary habits and body composition also contribute. The progression from normal liver to fibrosis and then to cirrhosis underscores the importance of early intervention.

How does liver cancer develop?

Approximately 80% of liver cancer cases occur in individuals with cirrhosis. While liver cancer can develop without cirrhosis, it's less common. Preventing the progression of cirrhosis is vital. Regular check-ups with liver specialists are recommended. Early detection is crucial, as treatment options become limited in advanced stages.

What factors are most harmful to the liver, and what dietary considerations should be made?

Alcohol is the most detrimental to liver health, accounting for about 80% of liver disease cases. Hepatitis B and C are also significant contributors. Maintaining a balanced diet is essential. Consuming protein-rich foods and avoiding harmful substances can help preserve liver function. Once cirrhosis is diagnosed, alcohol must be completely avoided.

What is the current state of liver transplantation in Nepal?

Liver transplantation becomes necessary when cirrhosis progresses beyond control or in certain cancer cases. In Nepal, living donor liver transplantation is common, requiring donors to be close relatives, as per the Human Organ Transplantation Act. The first liver transplant in Nepal was performed in 2016. Currently, three institutions, including the Human Organ Transplant Center in Bhaktapur, Teaching Hospital, and KIST Medical College, are actively conducting liver transplants.

What surgical methods are used for liver transplantation in Nepal?

Globally, 99% of liver transplants are performed using open surgery, which involves removing the damaged liver and replacing it with a healthy one from a donor. In Nepal, living donor transplants are prevalent, while other countries also utilize organs from brain-dead donors. Minimally invasive techniques, such as laparoscopic surgery, are emerging but are less common. Since the first liver transplant in 1960, the procedure has evolved significantly, with Nepal achieving a success rate comparable to international standards.

What are the costs associated with liver transplantation in Nepal?

Liver transplantation in Nepal is among the most affordable globally. The cost of 20 transplants in Nepal is equivalent to a single transplant in the USA. This affordability is due to lower manpower costs and minimal profit margins in private hospitals. However, the procedure remains expensive compared to other treatments, with total costs, including donor and patient expenses, ranging from NPR 3 to 3.5 million.

What precautions should liver transplant patients take post-surgery?

Post-transplant, patients receive immunosuppressive medications to prevent organ rejection, which can increase susceptibility to infections. Gradually, the body adapts to the new liver, but daily medication is essential. Patients with conditions like high blood sugar may require lifelong medication. Regular exercise and a healthy lifestyle are also crucial for recovery.

Any final thoughts on liver transplantation?

Liver transplantation has been practiced in Nepal for 8-9 years, with outcomes comparable to those in India. Many are unaware that such advanced procedures are available in Nepal at a lower cost. Donors undergo thorough testing to ensure their safety, and the liver regenerates within 1 to 1.5 months post-donation. To date, over 50 liver transplants have been performed without complications for donors. Donors do not require long-term follow-up and can maintain a normal lifestyle post-surgery.