Editor's note: Recently, the Combined GlHep&SHC 2024 was held in Singapore. This conference brings together elite scholars in the field of liver disease from around the world to discuss the latest developments, challenges, and opportunities in liver disease. Hepatology Digest invited Dr. Mark Muthiah from the National University Hospital, Singapore to conduct in-depth discussions on issues related to liver fibrosis and patient clinical management. The following is a transcript of the interview.Hepatology Digest: In your research, what do you consider to be the biggest challenge currently facing the field of reversing liver fibrosis? Are there any specific cellular therapy strategies that have shown broad prospects and the potential to more effectively promote the reversal of liver fibrosis?
Dr. Mark Muthiah: Thank you for having me. The biggest challenge in patients with liver cirrhosis and decompensated liver cirrhosis is the harsh environment of the liver, making it very difficult to reverse the fibrosis. What has shown benefit is actually treating the underlying disease—whether it’s hepatitis B, hepatitis C, or fatty liver disease. For hepatitis B and C, treating the virus is crucial, and for fatty liver disease, weight loss and controlling metabolic risk factors are essential. Currently, there are no specific treatments for fatty liver disease-related liver cirrhosis, but we hope that upcoming drugs will provide some solutions.
Hepatology Digest: What are the primary clinical management strategies for MAFLD currently practiced in Singapore?
Dr. Mark Muthiah: Our main strategy is weight loss through diet and lifestyle changes. Managing the patient holistically is very important. Currently, diet and lifestyle interventions are the only options we have, and they are crucial in the early stages of the disease to prevent progression. Unfortunately, once patients develop decompensated liver cirrhosis, the only option available is a liver transplant.
Hepatology Digest: You presented a report titled “A Patient-Centric View of Risk Assessment: Balancing Competing Risks.” How do you envision incorporating a patient-centric approach into the risk assessment for liver disease patients? When balancing competing risks in the management of liver disease from a patient-centric perspective, what are the key factors that you consider most important?
Dr. Mark Muthiah: When balancing competing risks, the main issue would be the comorbidities, especially cardiovascular comorbidities. Patients with fatty liver disease often have diabetes, high blood pressure, and high cholesterol. The choice of drug is critical. For instance, a patient with fatty liver disease and diabetes may have kidney problems. We need to decide which is more important and which problem will cause more issues. It requires a comprehensive approach to manage not just the liver, but also other organs at risk, and to select the most beneficial treatment for the patient.
Hepatology Digest: What are some of the most effective strategies or innovations in the management of decompensated MASH cirrhosis that you have encountered or implemented in your clinical practice? How do these strategies aim to improve patient outcomes and quality of life?
Dr. Mark Muthiah: For patients with decompensated MASH cirrhosis, the only definitive option is a liver transplant. However, this is complicated by other metabolic and cardiovascular issues. Even while waiting for a liver transplant, there is a higher risk of complications. We try to optimize the management of comorbidities while patients are on the transplant waiting list. This includes managing cardiovascular issues, comorbidities, and fluid status to get them safely to a transplant. Many of these patients also develop liver cancer, and managing the cancer to enable a successful liver transplant is crucial. Post-transplant, controlling metabolic issues continues to play a significant role in ensuring a good quality of life.
