Cryptogenic cirrhosis is the leading cause for listing for liver transplantation in Sri Lanka
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Cryptogenic cirrhosis is the leading cause for listing for liver transplantation in Sri Lanka R. C. Siriwardana & M. A. Niriella & C. A. H. Liyanage & S. R. Wijesuriya & B. Gunathilaka & A. S. Dassanayake & H. J. De Silva
Received: 1 April 2013 / Accepted: 29 July 2013 / Published online: 3 September 2013 # Indian Society of Gastroenterology 2013
Abstract Hepatitis B and C are rare in Sri Lanka. Nonalcoholic fatty liver disease is increasing in the country. Eighty-one patients referred for liver transplantation (LT) over a period of 18 months were prospectively evaluated. Ninetytwo percent (n = 74) were males. Cryptogenic cirrhosis was the leading indication for LT (58 %, n = 47) followed by alcohol in 27 % (n = 33). Hepatitis B and C were not seen in our cases. The liver biochemistry and clinical status of cirrhosis were similar in cryptogenic and alcoholic cirrhotics. Fourteen patients died while waiting for transplant, and nine transplants were performed. Cryptogenic cirrhosis is the leading cause for LT in Sri Lanka. Keywords Alcohol . Chronic liver disease . Nonalcoholic fatty liver disease
Introduction Globally, hepatitis B- and C-induced cirrhosis is the leading cause for liver transplantation. In most Asian countries, especially among the urban population, there has been a rapid change in the diet and lifestyle. As a result, an epidemic of nonalcoholic fatty liver disease (NAFLD) has been predicted [1, 2]. NAFLD is well-known to progress to cirrhosis [3, 4]. Parallel to this, it has been projected that NAFLD-induced cirrhosis would be the leading cause for liver transplantation (LT) in another 20 years [5]. In Sri Lanka, a country with a population of 19 million, hepatitis B and C are rare, unlike in the rest R. C. Siriwardana (*) : M. A. Niriella : C. A. H. Liyanage : S. R. Wijesuriya : B. Gunathilaka : A. S. Dassanayake : H. J. De Silva North Colombo Liver Transplantation Service, Ragama Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka e-mail: [email protected]
of the world. The country is rapidly urbanizing. More and more people have changed their habits and lifestyles. A previous large, urban, community-based ultrasound study detected NAFLD in 35 % of the population [6]. Cirrhotic patients from the country are referred to the North Colombo Liver Transplantation Service for evaluation.
Methods Patients who were referred for LT from March 2011 to September 2012 were the subjects of the study (Fig. 1). All the data were collected prospectively. Upon referral, all the patients were evaluated for the cause of cirrhosis by the hepatologists. Patients who had a history of consuming alcohol above the accepted safe limits (Asian standards,
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