Liver Disease Treatment: Medication, Transplant & More

Liver disease is a condition that affects the health and function of the liver. The liver is a hard-working organ that helps digest foods and process nutrients, filters and removes waste from the body, and supports various metabolic functions. 

The liver can repair and regenerate itself. Early detection and treatment can help the liver heal and prevent liver disease from progressing. With chronic (long-term) and advanced liver disease, damage to the liver may be irreversible, so treatment focuses on managing symptoms, slowing disease progression, and preventing complications like liver failure. 

Hepatologists (doctors specializing in diagnosing and treating liver diseases) and gastroenterologists (specializing in the gastrointestinal system and liver) treat liver disease. Treatment may include a combination of medications, lifestyle changes, and, in severe cases, surgical interventions such as liver transplantation.

There are over 100 types of liver disease, including fatty liver disease, hepatitis (inflammation), fibrosis (scarring), cirrhosis (severe scarring), and liver cancer. Although each form is unique and has different causes, symptoms, and treatments, all liver diseases damage the liver and affect its normal functioning. 

Treatment approaches for liver disease depend on the type and severity of the condition.

Treatments for Nonalcoholic Fatty Liver Disease (NAFLD)

Nonalcoholic fatty liver disease (NAFLD), or metabolic dysfunction-associated steatotic liver disease (MASLD), is a condition that develops when extra fat cells build up in the liver. Over 100 million people in the United States have NAFLD. Research suggests that up to 75% of people who are overweight and more than 90% of people with obesity have NAFLD.

There are no medical treatments for NAFLD. Treatment focuses on weight management and lifestyle changes that can help prevent or reverse liver damage (in the early stages). These include:

• Weight management: In people with overweight and obesity, losing 3-5% of body weight can help reduce fat in the liver, and losing 7-10% can help reduce liver inflammation and fibrosis (scarring). 
• Healthy diet: A nutritious, well-balanced diet with NAFLD includes eating plenty of fruits, vegetables, and whole grains and limiting fat intake, replacing saturated and trans fats with healthy fats (e.g., omega-3 fatty acids). Avoid or limit foods and beverages with a high glycemic index (GI), including white bread, rice, potatoes, sodas, and fruit juices. 
• Regular exercise: At least 150 minutes of weekly physical activity, including cardiovascular (aerobic) exercises and strengthening activities, can help you maintain a healthy body weight and support liver health. 
• Avoid alcohol: Alcoholic beverages can further damage the liver. 
• Manage underlying conditions: People with diabetes and high cholesterol have a higher risk of NAFLD. Following your treatment plan for these conditions and maintaining healthy lifestyle habits can help reverse or prevent liver damage. 

Treatments for Viral Hepatitis

Viral hepatitis is liver inflammation that develops due to an infection with different types of hepatitis viruses, most commonly hepatitis A, B, and C. Treatment options depend on the specific virus. 

• Hepatitis A: An acute (short-term) infection that usually disappears without treatment. Rest, drinking plenty of fluids, and eating healthy foods can help relieve symptoms and promote healing.
• Hepatitis B: Acute hepatitis B does not require treatment. Healthcare providers may treat chronic (long-term) hepatitis B with oral (taken by mouth) antiviral medications, such as Baraclude (entecavir), Vemlidy (tenofovir alafenamide), or Viread (tenofovir disoproxil fumarate), to help suppress the virus and prevent further liver damage.
• Hepatitis C: Acute hepatitis C usually resolves within six months without treatment. If your body cannot fight the infection and it becomes chronic, your healthcare provider may prescribe antiviral medicines to kill and cure the virus. Many new antiviral therapies, including Daklinza (daclatasvir), Zepatier (elbasvir/grazoprevir), and Olysio (simeprevir), can cure hepatitis C within 8-24 weeks.

Antiviral medications for treating chronic hepatitis B and C can cause side effects such as nausea, headache, fatigue, and insomnia.

Treatments for Alcohol-Related Liver Disease (ARLD) 

Alcohol-related liver disease (ARLD) develops when excessive alcohol consumption (two or more drinks daily) damages the liver, leading to progressive liver disease that occurs in stages: fatty liver, alcoholic hepatitis, and cirrhosis.

Treatments for alcohol-related liver disease include: 

• Alcohol abstinence: Complete abstinence from alcohol is crucial with any form of alcohol-associated liver disease. Discontinuing drinking can prevent further liver damage and may improve liver function over time. With fatty liver or alcoholic hepatitis, the liver may regenerate and repair itself once you stop drinking. 
• Medications: Corticosteroids, such as Millipred and Prednoral (prednisolone), can help reduce liver inflammation and promote healing. Campral (acamprosate) can reduce alcohol withdrawal symptoms, while ReVia, Vivitrol, and Depade (naltrexone) reduce alcohol cravings. 
• Nutritional support: Dietary habits, hypermetabolism (elevated calorie expenditure at rest), alcohol’s effects on fat absorbency, and how the body uses nutrients can lead to nutritional deficiencies and malnutrition. Dietary support and supplements like B vitamins, vitamin D, and zinc can help treat these deficiencies.

Treatments for Autoimmune Hepatitis 

Autoimmune hepatitis is a chronic condition in which the body’s immune system mistakenly attacks liver cells, leading to inflammation and liver damage. Treatments for autoimmune hepatitis reduce or suppress immune system activity to prevent worsening liver damage and may include:

• Corticosteroids: High-dose corticosteroids (e.g., prednisone) are a first-line treatment for autoimmune hepatitis. They help reduce liver inflammation and suppress the immune system to promote healing. You may initially take high-dose corticosteroids and gradually decrease the dose. Long-term use can cause serious side effects like weight gain, hypertension (high blood pressure), osteopenia (loss of bone density), diabetes, and mood changes. 
• Immunosuppressants: Imuran (azathioprine) is an immunosuppressant drug that reduces immune system activity to decrease liver inflammation and prevent liver damage. Healthcare providers typically prescribe this medicine after decreasing corticosteroid doses. Side effects include nausea or vomiting, skin rash, pancreatitis (pancreas inflammation), and an increased risk of infections. 

Treatments for Cirrhosis

Cirrhosis is a late-stage liver disease in which inflammation causes permanent liver scarring. Scarring replaces healthy liver tissue and prevents the liver from functioning normally. It also restricts blood flow to the liver and, when left untreated, can lead to liver failure.

Treatment for cirrhosis depends on the underlying cause and extent of liver damage and may include:

• Lifestyle modifications: Healthy lifestyle habits can help prevent further liver damage and reduce the risk of complications. These include avoiding alcohol, reducing sodium (salt) and protein intake, avoiding raw shellfish, and maintaining a healthy body weight. 
• Medications: Healthcare providers may prescribe medications to manage the underlying cause of cirrhosis and prevent more liver damage. 
• Liver transplantation: When cirrhosis leads to liver failure, a liver transplant is a life-saving procedure that involves removing your liver and replacing it with a healthy liver from another person (donor).

Treatments for Liver Cancer 

Liver cancer develops when abnormal cells in the liver grow and multiply uncontrollably, forming a tumor. Primary liver cancer is when cancer initially develops in the liver. Secondary liver cancer is when cancer in another area spreads to the liver.

Treatments for liver cancer depend on the stage and type of liver cancer and may include:

• Surgery: Removing the part of the liver affected by cancer
• Ablation: Targeting and destroying cancer cells in the liver using cryotherapy (extreme cold), radiofrequency (high-frequency radio waves), or microwave therapy (high temperatures)
• Embolization: Using substances that block or decrease blood flow through the hepatic (liver) artery to cut off oxygen and nutrients from the tumor while ensuring healthy liver tissues continue to receive oxygen and nutrient-rich blood
• Targeted therapy: Medications such as bevacizumab, cabozantinib, and lenvatinib that attack specific cancer cells to prevent advanced liver cancer from worsening
• Immunotherapy: Medications such as atezolizumab, durvalumab, and nivolumab that boost the immune system’s defenses against cancer
• Radiation therapy: Directing high-energy X-rays or other types of radiation directly at a tumor or tumors on the liver to destroy cancer cells

The prognosis and life expectancy for liver disease depend on the type and severity of the disease. Early diagnosis and treatment of liver diseases can help improve outcomes. Following your treatment plan and making lifestyle changes that help your liver heal can prevent further damage. 

More advanced liver disease can reduce life expectancy and increase the risk of potentially life-threatening complications, such as liver failure. For example: 

• The life expectancy of people with compensated cirrhosis (when the liver can still function despite extensive damage) is 9-12 years after diagnosis.
• With decompensated cirrhosis (when liver function deteriorates), most people have a life expectancy of about two years.

Research advancements and emerging treatments, including new antiviral therapies for hepatitis and ongoing research into liver regeneration, provide hope for better outcomes in people with advanced liver disease.

The most important step you can take for your health is to stay actively involved in your care. Schedule regular checkups with your healthcare provider, follow recommended screenings, and make the most of your appointments by asking questions to understand how to protect your liver health. 

Living with liver disease can affect nearly every aspect of your life, including your physical health, emotional well-being, and daily activities. Following your treatment plan and proactively protecting your health helps you live with liver disease. Here are some recommendations:

• Follow your treatment plan: Following your healthcare provider’s recommendations for medications, lifestyle modifications, and follow-up appointments is crucial. Your provider can work with you to ensure effective treatments and catch any signs of disease progression early. 
• Join a support group: People with similar experiences can offer practical advice, emotional support, and a sense of community. The American Liver Foundation offers online support groups and a Caring Connections peer-to-peer support program that connects people with liver disease with others facing similar challenges. 
• Educate yourself: Learning as much as possible about your condition and treatment options can help you feel confident in making informed decisions about your care. 
• Lifestyle modifications: Healthy lifestyle choices, including a healthy diet, avoiding alcohol, engaging in regular physical activity, and maintaining a healthy body weight, can improve and protect your liver health.