Liver Disease & Failure

An acute liver injury is one that happens quickly. It occurs when you experience brief but severe liver trauma. The damage may resolve or get better by itself. But even an acute liver injury can lead to liver failure if it’s severe. Liver failure occurs when your liver doesn’t function as it should.

Chronic liver disease refers to gradual liver damage that happens over time. It lasts more than six months and may lead to fibrosis. This is where your liver, to compensate for the damage, replaces normal tissue with fibrous tissue. Fibrosis, in turn, can progress to cirrhosis. Cirrhosis causes broad bands of scarring to develop and surround regrowing liver tissue. The progressive scarring destroys liver cell function and can lead to many serious complications. Some of these complications include portal hypertension (high blood pressure within the liver), ascites (fluid buildup within the abdomen) and intestinal bleeding. It can also result in liver failure.

Our liver doctors treat both acute and chronic liver disease.

Sometimes, early liver disease doesn’t cause any symptoms. Your doctor may detect a problem through blood tests or during a routine checkup. The doctor may order additional blood work or imaging tests to confirm a diagnosis.

At one time, diagnosing fibrosis in your liver required a biopsy. This is a procedure where doctors remove a small piece of liver tissue with a needle or through hepatobiliary surgery. The Liver Center at BIDMC offers a non-invasive diagnostic test. It can reveal any fibrosis and fatty deposits in your liver. With the results, doctors can quickly determine whether you are at risk for progression to cirrhosis. This simple test is similar to ultrasound. It’s available in many of our locations in and around Boston. This test can also be done via MRI if your doctor believes a more detailed evaluation is required, which is called MRI elastography.

Treatment for liver disease depends on your specific condition. In general, stopping alcohol use is always important. Medication, counseling with specialists from behavioral health and/or an addiction recovery program may be helpful. Doctors may recommend other lifestyle changes, such as losing weight and controlling blood sugar levels for conditions like metabolic dysfunction associated steatotic liver disease - sometimes referred to as fatty liver disease. Getting vaccinated for hepatitis B and C may also help protect your liver.

Medication can play a role in many conditions. For example, medicine may slow the progress of cirrhosis or control blood pressure if you have portal hypertension. We can also use medication to suppress your immune system if you have autoimmune hepatitis.

Examples of other treatments include:

• Dietary changes, such as limiting copper in your diet if you have Wilson’s disease.
• Nutritional support to make sure you get the nutrients you need.
• Surgery to remove tumors or blockages or treat complications.
• Therapeutic phlebotomy to remove blood (and iron) if you have hemochromatosis.

Alcoholic Liver Disease (ALD) Program

Our ALD Program provides compassionate care and clinical trials for liver disease related to alcohol-related liver disease.

Autoimmune & Cholestatic Disease Program

Our Autoimmune and Cholestatic Liver Disease Program provides care for liver issues related to complications of autoimmunity. The most common autoimmune diseases we treat include:

• Autoimmune hepatitis: a chronic condition that occurs when your immune system attacks your liver, causing inflammation.
• Primary biliary cholangitis: occurs when your immune system attacks your biliary ducts (the ducts that carry bile between your liver, gallbladder and small intestine) within your liver. This interferes with your liver’s ability to excrete bile, which is stored in your gallbladder.
• Primary sclerosing cholangitis: causes inflammation and scarring of the bile ducts. As a result, bile may have a hard time getting through.

These three conditions may occur by themselves or there may be some overlap. Other conditions we treat at the clinic include:

• Autoimmune and IgG-4 related cholangiopathies
• Complex autoimmune disease
• Liver disease related to inflammatory bowel disease
• Sarcoid-related liver disease

Through our research, we work to better understand autoimmune liver disease and discover new treatments. As a patient of the clinic, you have access to our ongoing and future clinical trials.

We work closely with experts from rheumatology, our Inflammatory Bowel Disease (IBD) Center, the Advanced Endoscopy Center, the Transplant Institute and the Liver Tumor Program to help you receive comprehensive care.

At the end of each visit, you receive a detailed summary of your diagnosis, treatment plan and next steps in care. We will coordinate any further testing that may be needed. We also communicate with your primary care physician and local specialists.

Transplant Institute

If you have advanced or end-stage liver disease, we work closely with specialists at the Transplant Institute to determine if a liver transplant is right for you.

If you’re seriously ill because of your liver condition and you have no other treatment options, it may be time to consider a liver transplant. Some of the most common reasons for liver transplant at BIDMC include the following:

• Acute liver failure
• Autoimmune hepatitis
• Caroli’s disease
• Choledochal cyst: a cyst that forms because of a structural flaw in your bile duct
• Chronic viral hepatitis B,C,D
• Cirrhosis
• Liver trauma
• Liver tumors
• Metabolic and genetic disorders
• Nonalcoholic fatty liver disease
• Primary sclerosing cholangitis
• Toxic exposure to pesticides, herbicides, asbestos and other hazardous pollutants
• Vascular disorders such as Budd-Chiari syndrome, which causes clotting in liver veins

Several other disorders and illnesses can also cause liver failure and lead to the need for a transplant:

• Adult polycystic disease: multiple cysts or sacs within the liver
• Alagille’s syndrome: too few bile ducts in the liver
• Amyloidosis: abnormal deposits of the amyloid protein in liver tissue
• Sarcoidosis: small lumps of cells in the liver 

Liver Failure Program

Our Liver Failure Program gives you access to a team of specialists. They have expertise in caring for people with worsening liver function.

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Program

The MASLD program at BIDMC brings together hepatologists and pharmacy team members to provide care for Metabolic Dysfunction-Associated Steatotic Liver Disease - formerly referred to as non-alcoholic fatty liver disease - and associated conditions.

Through the Liver Center, you can receive noninvasive diagnostic testing for MASLD. It can quickly determine whether you have MASLD, and if so, whether you’re at risk for progression to cirrhosis.

We work closely with BIDMC’s Advanced Endoscopy Center and Transplant Institute to deliver seamless care. This might include a specialized procedure or surgery.

Doctors and scientists at BIDMC also conduct cutting-edge MASLD research. Their work has been recognized around the world.

Viral Hepatitis Program

Specialists in the Liver Center are experts in diagnosing all forms of viral hepatitis. Our team consists of physicians, physician assistants, nurse practitioners and clinical pharmacists. Research staff are also part of the team. Current treatments that are available for viral hepatitis have been developed in collaboration with physicians at BIDMC. Our researchers continue to innovate in diagnosis and treatments to advance the field of viral hepatitis.

Treatment for viral hepatitis is available at BIDMC in Boston, Chestnut Hill, Chelsea, Lexington and Plymouth.