1 in 3 Urban Sri Lankan Adults Studied Had Fatty Liver. Could You Have It Without Knowing?

Author: Prof. Thamara Perera

Liver Transplantation

Many people live for 10, 20 years or even longer after a successful liver transplant. Current published figures vary between countries, transplant centres and patient groups, but Mayo Clinic reports that around 75% of liver transplant recipients are alive at five years and about 60% live for 10 years or longer. Some transplanted livers continue functioning for several decades. Your individual outlook depends on your health, the reason for transplantation, complications and long-term follow-up.

Medically reviewed by Prof. Thamara Perera MBBS, MS, FEBS, MD, FRCS · Consultant Hepatobiliary & Liver Transplant Surgeon

That makes liver transplantation very different from simply “buying a few more years”.

For many patients with end-stage liver disease, transplantation offers the possibility of returning to work, spending time with family, travelling and rebuilding a life that had gradually become limited by illness.

But survival statistics need to be understood properly.

They tell us what happened to large groups of transplant recipients. They cannot tell one individual exactly how long he or she will live.

What are the survival rates after a liver transplant?

Liver transplantation has become a well-established treatment for selected patients with end-stage liver disease, acute liver failure and certain liver cancers.

Different transplant systems report slightly different outcomes.

NHS Blood and Transplant currently states that 93 out of 100 patients were alive one year after liver transplantation and 83 out of 100 were alive at five years, based on its 2019/20 annual transplant report. Mayo Clinic states that about 75% survive at least five years and around 60% live for 10 years or longer.

These differences do not mean one figure is “right” and another is “wrong”. Survival varies according to the country, transplant centre, patient population, donor type, underlying liver disease and time period being studied.

The more useful message is this: a successful liver transplant can provide many years — and sometimes decades — of life.

Can you live 20 years or longer after a liver transplant?

Yes.

There are people who have lived for decades after liver transplantation.

The Scientific Registry of Transplant Recipients notes that the longest-functioning liver transplants have lasted several decades.

A patient who receives a transplant at 40, for example, should not automatically assume that the transplanted liver has a fixed 10-year expiry date.

There isn’t one.

Some transplanted livers continue functioning for many years beyond that point.

However, the longer-term health of a transplant recipient depends not only on the liver itself but also on the rest of the body.

That is why long-term transplant care looks beyond liver tests alone. Doctors also monitor kidney function, blood pressure, diabetes, cardiovascular health, infections, cancers and the effects of long-term medication.

Does a transplanted liver last for life?

It can, but there is no guarantee that every transplanted liver will last for the rest of a person’s life.

A transplanted liver may function successfully for decades.

In some people, however, complications can eventually damage the transplanted liver.

These may include rejection, problems involving the bile ducts or blood vessels, recurrent liver disease, infection or other medical conditions.

A small number of patients may eventually need another transplant.

SRTR therefore describes liver transplant longevity in terms of several decades, while emphasising that the lifespan of the transplanted organ depends on factors related to both the recipient and donor.

What affects how long you live after a liver transplant?

There is no single factor.

Long-term survival can be affected by:

your age and overall health at transplantation
the disease that caused the original liver failure
kidney, heart or metabolic conditions
the health and characteristics of the donor liver
surgical and early post-transplant complications
infections
rejection
whether the original liver disease can recur
taking anti-rejection medication correctly
long-term medical follow-up
smoking, alcohol and other lifestyle factors

This is why two people who undergo liver transplantation at the same age may have very different long-term outcomes.

The transplant is a major turning point.

But what happens after transplantation continues to matter.

Why is the first year after a liver transplant important?

The first year receives particularly close attention because this is when several important post-transplant complications are more likely to occur.

Immediately after surgery, the transplant team needs to make sure the new liver is functioning properly.

They also monitor for complications such as bleeding, infection, bile duct problems, blood-vessel complications and rejection.

Medication doses may need to be adjusted frequently during this period.

Follow-up is therefore much more intensive during the early months.

As recovery progresses and liver function becomes stable, appointments may become less frequent.

Passing the first year successfully is an important milestone — but transplant care does not stop there.

Long-term monitoring continues throughout life.

Does a living donor liver transplant have different outcomes?

Living donor liver transplantation involves transplanting a portion of a healthy person’s liver into the recipient.

The liver is unusual because both the remaining liver in the donor and the transplanted portion in the recipient have the ability to grow after surgery.

Living donation can have an important advantage: the transplant can sometimes happen before the recipient becomes critically ill while waiting for a deceased-donor organ.

Comparing living and deceased donor outcomes is complicated because patients receiving living-donor transplants may be transplanted earlier.

Current AASLD educational guidance notes that, after adjustment for relevant donor and recipient factors, long-term patient and graft survival are similar between living-donor and deceased-donor transplantation, although the complication profiles can differ.

So the important question is not simply which type is “better”. It is whether the donor, recipient, timing and transplant approach are appropriate for the individual patient.

Can liver disease return after transplantation?

Some liver diseases can recur after transplantation.

The answer depends on why the original liver became damaged.

The transplanted liver does not automatically carry the same disease as the liver that was removed. But some conditions affecting the patient can also affect the new liver over time.

This is one reason lifelong specialist follow-up remains important even when someone feels completely well.

Doctors monitor the transplanted liver through clinical reviews and blood tests and may use additional investigations when necessary.

Finding a problem early is usually far better than waiting until symptoms appear.

Will I need anti-rejection medicine for life?

For most liver transplant recipients, immunosuppressive or anti-rejection medication is required long term, usually lifelong.

Your immune system is designed to recognise things that do not belong to your body. That includes a transplanted organ.

Immunosuppressive medicines reduce the immune response so that the body is less likely to attack the transplanted liver.

The dose may change over time, particularly after the early transplant period.

These medicines also require careful monitoring because they can increase susceptibility to infection and contribute to other long-term health issues.

Do not stop or change anti-rejection medication without advice from your transplant team.

Can you live a normal life after a liver transplant?

For many people, yes — although “normal” may look slightly different after transplantation.

The goal of liver transplantation is not simply survival. It is to restore meaningful life and function.

Mayo Clinic describes return to active life as an expectation after successful transplantation, including patients returning to work and physical activity.

Recovery takes time.

In the beginning, life can revolve around blood tests, medication, clinic appointments and preventing infection.

Over time, many recipients are able to return to everyday activities. They may work, travel, exercise and participate in family life.

What does not disappear is the need to look after the transplanted liver. A person can feel completely well and still need regular follow-up.

What can help protect your transplanted liver?

The most important part of life after transplantation is consistency.

Take medication exactly as prescribed.
Attend transplant follow-up appointments even when you feel well.
Complete blood tests and other monitoring recommended by your transplant team.
Maintain a healthy weight and remain physically active as advised.
Control diabetes, cholesterol and blood pressure.
Avoid smoking.
Discuss alcohol with your transplant team rather than assuming it is safe.
Check before starting herbal remedies, supplements or new medicines because some can interact with transplant medication.
Report unexplained fever, jaundice, significant abdominal pain, persistent vomiting or other concerning symptoms rather than waiting for the next appointment.

A transplant gives the liver a second start. Protecting it becomes a long-term partnership between the patient and the transplant team.

Frequently Asked Questions

What is the five-year survival rate after liver transplant?

Published survival rates differ among countries and patient populations. Mayo Clinic reports that approximately 75% of people receiving a liver transplant survive for at least five years. NHS Blood and Transplant reports 83% five-year survival based on its 2019/20 UK data.

Can you live 10 years after a liver transplant?

Yes. Mayo Clinic reports that approximately 60% of liver transplant recipients live for 10 years or longer. Individual outcomes vary considerably.

Can you live 20 years after a liver transplant?

Yes. Some liver transplant recipients live 20 years or considerably longer. SRTR notes that functioning liver transplants can last several decades.

How long does a transplanted liver last?

There is no fixed lifespan. A transplanted liver can function for several decades, although this depends on recipient health, donor factors, complications and long-term care.

Can you live a normal life after a liver transplant?

Many recipients return to work, family life, exercise and other normal activities after recovery. Lifelong medication and medical follow-up remain necessary for most patients.

Is a living donor liver transplant less successful?

Not necessarily. Current AASLD educational guidance notes that long-term patient and graft survival are similar between appropriately selected living-donor and deceased-donor liver transplant recipients after adjustment for relevant differences.

Can a transplanted liver fail?

Yes. Rejection, vascular or biliary complications, recurrent disease and other medical problems can damage a transplanted liver. Some patients may eventually require consideration of retransplantation.

Will I need medication for the rest of my life?

Most liver transplant recipients require long-term, usually lifelong, immunosuppressive medication to reduce the risk of rejection.

About Prof. Thamara Perera

Prof. Thamara Perera, MBBS, MS, FEBS, MD, FRCS, is a Consultant Hepatobiliary and Liver Transplant Surgeon at Kings Hospital Colombo.

He previously served as Lead Consultant in Liver Transplantation at Queen Elizabeth Hospital Birmingham and as a Consultant in Paediatric Transplantation at Birmingham Children’s Hospital.

His clinical experience includes more than 1,300 adult and paediatric liver transplant operations, together with extensive experience in complex liver transplantation and transplant research.

Medically reviewed by: Prof. Thamara Perera · Last reviewed: September 2026

More about Prof. Thamara Perera

Medical References

Mayo Clinic — Liver Transplant: Results and Survival Rates.
NHS Blood and Transplant — Benefits and Risks of a Liver Transplant.
Scientific Registry of Transplant Recipients — Long-term Liver Transplant Outcomes.
American Association for the Study of Liver Diseases — Living Donor Liver Transplantation and Long-term Outcomes.

This article provides general health information. Survival statistics describe groups of patients and cannot predict an individual patient’s outcome. Individual prognosis should be discussed with the patient’s transplant team.

Considering a liver transplant assessment?

A specialist consultation can help explain the transplant pathway, discuss donor options and answer questions about long-term outlook.

Book a Consultation View Patient Resources →

August 14, 2026

How do Omega 3 fatty acids help you have a healthy heart?

Author: Prof. Thamara Perera

Liver Health & Symptoms

Liver failure can be difficult to recognise early because liver disease may cause few or no symptoms until significant damage has occurred. Warning signs that liver function may be worsening include yellowing of the eyes or skin, swelling of the abdomen or legs, confusion, unusual bleeding or bruising, vomiting blood or passing black stools, severe tiredness and changes in urine or stool colour. These symptoms do not automatically mean your liver is failing, but they should not be ignored.

Medically reviewed by Prof. Thamara Perera MBBS, MS, FEBS, MD, FRCS · Consultant Hepatobiliary & Liver Transplant Surgeon

Your liver does hundreds of jobs quietly every day.

It processes nutrients, helps remove waste from the blood, produces proteins needed for blood clotting and helps regulate many of the body’s essential functions.

The difficulty is that your liver can continue working even after it has been damaged.

This means someone can have significant liver disease and still feel relatively well.

So how do you know when your liver is beginning to struggle?

First: liver damage and liver failure are not the same thing

Having fatty liver, abnormal liver enzymes or even cirrhosis does not automatically mean that your liver is failing.

Liver disease can progress over time.

A simplified pathway may look like:

Liver injury → fibrosis → cirrhosis → decompensated liver disease → liver failure

Even people with cirrhosis may remain relatively stable for a period of time. Doctors often refer to this as compensated cirrhosis.

The more serious turning point is when complications begin to appear because the liver can no longer compensate adequately.

This is known as decompensated cirrhosis. Ascites, hepatic encephalopathy and bleeding from enlarged veins in the digestive tract are among the major signs of decompensation.

1. Your eyes or skin are becoming yellow

One of the most recognisable signs of serious liver dysfunction is jaundice.

You may first notice that the whites of your eyes look yellow. The skin can also develop a yellow colour, although this may be less obvious on darker skin tones.

Jaundice happens when bilirubin — a yellow pigment produced as red blood cells break down — builds up in the body instead of being processed and removed normally.

Jaundice has several possible causes and does not always mean liver failure.

But new or worsening jaundice should always be medically assessed, particularly in someone with known liver disease.

2. Your stomach is becoming swollen

A stomach that becomes noticeably larger is not always weight gain.

Advanced liver disease can cause fluid to collect inside the abdomen. This is called ascites.

People may describe:

a rapidly increasing waistline
a tight or heavy abdomen
difficulty fitting into clothes
feeling full after eating only a small amount
discomfort or shortness of breath as the swelling increases

Fluid may also collect around the ankles, feet and lower legs.

Ascites is an important development in someone with cirrhosis. AASLD identifies it as one of the main events that marks liver disease becoming decompensated, and patients with clinically significant ascites should be considered for specialist assessment, including transplant evaluation when appropriate.

3. You are becoming confused, forgetful or unusually sleepy

This is one of the warning signs families often notice before the patient does.

A person with advanced liver disease may begin to:

struggle to concentrate
become unusually forgetful
reverse their sleep pattern
appear confused
behave differently
become very sleepy
have difficulty carrying out familiar tasks

This can happen because a badly damaged liver is less able to remove certain toxins from the blood.

When those substances affect the brain, the condition is called hepatic encephalopathy.

It can range from subtle concentration or sleep problems to severe confusion and reduced consciousness.

Sudden or significant confusion in someone with liver disease requires urgent medical attention.

4. You are bruising or bleeding more easily

Your liver makes several proteins needed for normal blood clotting.

As liver function deteriorates, the body’s ability to control bleeding can be affected.

You may notice:

bruises appearing more easily
bleeding that takes longer to stop
frequent nosebleeds
bleeding from the gums

However, bruising has many possible causes, including medicines and blood disorders, so it should not be used on its own to diagnose liver failure.

When it occurs together with jaundice, swelling or known advanced liver disease, it deserves further investigation.

5. You vomit blood or pass black stools

This is different from simply bruising easily.

Advanced cirrhosis can cause increased pressure in the veins carrying blood through the liver. This is known as portal hypertension.

As that pressure rises, enlarged veins called varices can develop in the oesophagus or stomach.

If they rupture, they can cause serious internal bleeding.

A person may:

vomit fresh blood
vomit material that resembles coffee grounds
pass very dark or black stools
become faint, weak or dizzy

Vomiting blood or passing black, bloody stools is a medical emergency. Go to hospital immediately.

6. You are becoming increasingly weak, losing weight or losing your appetite

Tiredness alone does not mean your liver is failing.

Fatigue is extremely common and has many possible causes.

But persistent fatigue combined with other changes may be significant.

People with worsening chronic liver disease can develop:

severe tiredness
weakness
loss of appetite
nausea
unintentional weight loss
loss of muscle mass

Muscle loss can sometimes be overlooked because a person’s abdomen may simultaneously become larger from fluid.

Early cirrhosis can also cause tiredness, appetite loss, nausea, weight loss and discomfort around the upper-right abdomen.

The key is not one symptom in isolation.

It is the pattern of symptoms and how they are changing over time.

7. Your urine becomes very dark or your stools unusually pale

Changes in urine and stool colour can sometimes occur when the liver or bile system is not processing and excreting bilirubin normally.

Dark urine can accompany jaundice, while stools may become lighter or pale.

Some people with liver disease also develop significant itching.

These symptoms have several possible causes — including conditions involving the gallbladder or bile ducts — so they do not automatically mean liver failure.

But unexplained changes, particularly when accompanied by yellow eyes or skin, should be investigated.

Can my liver be badly damaged even if I feel fine?

Yes.

This is one of the most important things to understand about chronic liver disease.

Cirrhosis can be present without obvious symptoms, particularly in its earlier stages. Symptoms may only become noticeable once the liver is significantly damaged.

That is why people with known risk factors should not rely only on how they feel.

These risk factors can include:

fatty liver disease
long-term heavy alcohol use
hepatitis B or C
autoimmune liver disease
certain inherited or metabolic liver diseases
previously diagnosed liver fibrosis or cirrhosis

Regular medical monitoring can identify deterioration before dramatic symptoms appear.

My liver enzymes are normal. Does that mean my liver is fine?

Not necessarily.

This is a common misunderstanding.

Tests such as ALT and AST can help doctors identify liver-cell injury, but abnormal results do not always tell doctors how badly the liver is functioning.

Importantly, liver blood tests may sometimes be relatively normal even in advanced liver disease.

Doctors therefore interpret blood tests together with your symptoms, history, physical examination and imaging.

How do doctors know whether the liver is failing?

There isn’t one single test that answers the question.

Doctors may assess several things together.

Blood tests

These can include tests that look at:

Bilirubin — how effectively bilirubin is being processed and removed.

Albumin — an important protein produced by the liver.

INR or clotting tests — which can help assess the liver’s ability to produce proteins needed for blood clotting.

Other blood tests can help doctors assess kidney function, infection, blood-cell counts and possible causes of liver disease.

Imaging

Ultrasound, CT, MRI or liver elastography may be used depending on the patient’s condition.

Clinical examination

Signs such as jaundice, ascites, swelling, muscle loss, confusion or evidence of bleeding can provide important information.

Doctors may also use validated scoring systems to assess the severity of advanced liver disease and whether transplant assessment should be considered.

Diagnosis of cirrhosis and advanced liver disease is therefore based on the whole clinical picture, not simply one abnormal liver result.

Can a failing liver recover?

It depends on why the liver is failing and how advanced the damage has become.

Some liver injuries can improve when the underlying cause is identified and treated early.

But advanced cirrhosis causes permanent scarring.

Treatment may then focus on controlling the cause of the liver disease, managing complications and preventing further deterioration.

When liver function becomes severely impaired despite treatment, liver transplantation may need to be considered.

This does not mean every patient with cirrhosis needs a transplant.

The decision depends on the severity of disease, complications, overall health and detailed specialist assessment.

When should you seek urgent medical help?

Seek urgent medical attention if someone with known or suspected liver disease develops:

Vomiting blood
Black or bloody stools
New or worsening confusion
Marked drowsiness or difficulty waking
Rapidly increasing abdominal swelling
Significant new jaundice accompanied by deterioration

These can represent serious complications of advanced liver disease and should not wait for a routine appointment.

Frequently Asked Questions

What are the first signs that your liver is struggling?

Early symptoms can be vague and may include persistent tiredness, reduced appetite, nausea, unexplained weight loss, itching or discomfort in the upper-right abdomen. However, some people with significant liver disease have no early symptoms at all.

What are the most serious signs of liver failure?

Jaundice, fluid accumulation in the abdomen, confusion, significant bleeding and vomiting blood or passing black stools can indicate advanced liver disease or its complications and require medical assessment.

Can you have liver failure without knowing it?

Chronic liver disease can progress for years with few symptoms. However, once true liver failure or decompensation develops, complications such as jaundice, ascites, encephalopathy or bleeding commonly begin to appear.

Does fatty liver mean my liver is failing?

No. Fatty liver means excess fat has accumulated in the liver. Many people with fatty liver do not have liver failure. The concern is whether inflammation and fibrosis have developed and whether liver function has become impaired.

Does cirrhosis mean my liver has failed?

Not necessarily. A person may have cirrhosis while the liver is still compensating adequately. Liver disease becomes much more serious when complications such as ascites, encephalopathy or variceal bleeding develop.

Can normal liver tests rule out advanced liver disease?

No. Some liver blood tests may remain normal despite advanced liver disease, which is why doctors interpret laboratory results alongside medical history, examination and imaging.

What happens when the liver starts failing?

As liver function deteriorates, the body may have increasing difficulty processing bilirubin and toxins, maintaining normal fluid balance and producing proteins involved in blood clotting. This can contribute to jaundice, swelling, confusion and bleeding.

When should someone with liver disease see a transplant specialist?

Transplant evaluation may be considered when advanced liver disease begins causing significant complications or when liver function continues to deteriorate despite appropriate treatment. The decision requires specialist assessment rather than one symptom or test result alone. AASLD specifically recommends considering transplant evaluation when patients with cirrhosis develop clinically significant ascites and related complications.

About Prof. Thamara Perera

Prof. Thamara Perera, MBBS, MS, FEBS, MD, FRCS, is a Consultant Hepatobiliary and Liver Transplant Surgeon at Kings Hospital Colombo.

He previously served as Lead Consultant in Liver Transplantation at Queen Elizabeth Hospital Birmingham and as a Consultant in Paediatric Transplantation at Birmingham Children’s Hospital. His clinical and research work spans liver transplantation, complex hepatobiliary surgery and innovations in transplantation including normothermic machine perfusion.

Prof. Perera has been directly involved in more than 1,300 adult and paediatric liver transplant operations during his career.

Medically reviewed by: Prof. Thamara Perera · Last reviewed: September 2026

More about Prof. Thamara Perera

Medical References

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) — Cirrhosis: Symptoms, Diagnosis and Treatment.
American Association for the Study of Liver Diseases (AASLD) — Guidance on cirrhosis, ascites and hepatic decompensation.
NHS — Cirrhosis and advanced liver-disease symptoms.

This article provides general health information and is not a substitute for individual medical assessment.

Worried about advanced liver disease?

A specialist consultation can help assess liver function, review your symptoms and discuss whether further investigation or treatment is needed.

Book a Consultation View Patient Resources →

August 14, 2026

How Long Can You Live After a Liver Transplant? 5, 10 and 20 Years Explained

Author: Prof. Thamara Perera

Liver Health & Symptoms

Fatty liver is common in Sri Lanka and often causes no symptoms. A study of nearly 3,000 urban Sri Lankan adults aged 35–64 found fatty liver in 32.6% of participants — roughly 1 in 3 people studied. While fatty liver can remain mild, in some people it can progress to liver inflammation, scarring, cirrhosis and, eventually, liver failure. The key is finding out whether there is simply fat in the liver or whether liver damage has already begun.

Medically reviewed by Prof. Thamara Perera MBBS, MS, FEBS, MD, FRCS · Consultant Hepatobiliary & Liver Transplant Surgeon

The bigger concern is that many people do not know they have it.

For some, fatty liver remains mild. For others, it can lead to inflammation, scarring, cirrhosis and eventually serious liver disease.

What exactly is fatty liver?

Your liver normally contains a small amount of fat. Fatty liver disease develops when too much fat builds up inside liver cells.

Today, doctors increasingly use the term Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) for fatty liver associated with metabolic risk factors. You may still hear the older terms “fatty liver” or “NAFLD”, and these remain the words most patients recognise.

Fatty liver is often linked with conditions such as diabetes, high cholesterol, high triglycerides, excess weight around the waist and high blood pressure.

But having fatty liver does not automatically mean that your liver is failing.

The important difference is whether there is simply fat in the liver or whether inflammation and scarring have begun.

Can I have fatty liver without any symptoms?

Yes. And this is very common.

Fatty liver is often described as a “silent” disease because many people have few or no symptoms.

You might discover it almost accidentally.

Perhaps you had an ultrasound for abdominal pain. Perhaps your liver enzymes were slightly abnormal during a routine blood test. Or perhaps you were being investigated for diabetes or cholesterol and your doctor suggested checking your liver.

Some people may experience tiredness or a vague discomfort beneath the ribs on the upper right side of the abdomen, but these symptoms are not specific to fatty liver.

So feeling well does not necessarily tell you what is happening inside your liver.

Who is more likely to develop fatty liver?

Your risk is higher if you have type 2 diabetes, excess weight — particularly around your abdomen — high triglycerides or abnormal cholesterol, high blood pressure, insulin resistance or several of these conditions together.

The Sri Lankan urban study also found fatty liver was strongly associated with features of metabolic syndrome, including obesity, insulin resistance, raised blood glucose and triglycerides.

This is why someone who has been told repeatedly that their “sugar is a little high”, their cholesterol needs watching or their waistline is increasing should not think of each issue separately.

Your liver can be part of the same metabolic picture.

I’m not overweight. Can I still get fatty liver?

Yes.

This is particularly important for South Asian patients because fatty liver is not limited to people who appear overweight.

Sri Lankan researchers have specifically studied lean fatty liver disease. In one large community cohort, 120 people — 4% of the entire study population — had fatty liver despite being classified as lean.

So “I am thin, therefore my liver must be fine” is not a safe assumption.

Family history, diabetes, cholesterol, body-fat distribution, diet, activity and other metabolic factors can all matter.

When does fatty liver become dangerous?

Fatty liver does not progress in exactly the same way in every person.

For many people, fat accumulates without causing advanced liver damage.

In others, however, the liver can become inflamed. Over time, repeated inflammation may cause fibrosis — scarring of the liver.

The progression can look like this:

Fatty liver → inflammation → fibrosis → cirrhosis → liver failure or liver cancer

That does not mean everyone with fatty liver will reach cirrhosis.

It means that once fatty liver has been found, it is useful to understand where you are on that pathway rather than simply being told, “You have a fatty liver.”

Sri Lankan research has highlighted fatty liver disease as an important contributor to chronic liver disease and liver cancer in the country.

My ultrasound says fatty liver. What should I do next?

First, don’t panic.

But don’t ignore it either.

An ultrasound can show that fat is present in the liver. What it cannot reliably tell you is how much inflammation or scarring is present.

Your doctor may look at your medical history, weight and waist measurement, diabetes and cholesterol status and blood-test results. Certain blood-test combinations can also be used to calculate scores such as FIB-4, which help estimate the likelihood of significant liver fibrosis.

If necessary, tests such as liver elastography or FibroScan can assess liver stiffness, which may indicate fibrosis.

Not everyone needs every test, and not everyone with fatty liver needs a liver biopsy.

The goal is to answer a more useful question: is this simply fat in the liver, or is there evidence that the liver is becoming scarred?

Can fatty liver be reversed?

In many people, particularly when it is identified early, fatty liver can improve significantly.

The liver has an impressive ability to recover when the factors causing damage are addressed.

For people who are overweight, gradual and sustained weight loss can reduce liver fat. AASLD notes that around 5–10% weight reduction can produce meaningful improvements in liver fat, inflammation and fibrosis, depending on the individual and the stage of disease. Regular physical activity is also beneficial.

Treatment may also involve better control of diabetes, cholesterol, triglycerides and blood pressure, as well as reviewing alcohol intake, diet and medications.

This does not mean following a crash diet or attempting a “liver detox”.

In fact, rapid weight loss and some unregulated herbal or nutritional products can cause problems of their own. Management should be appropriate to the individual and the condition of the liver.

Is fatty liver the same as cirrhosis?

No.

Fatty liver means there is excess fat inside the liver.

Cirrhosis means there has already been substantial and permanent scarring of liver tissue.

There can be several stages between the two.

This is why discovering fatty liver early can be valuable. It gives patients and doctors an opportunity to identify the cause, assess whether fibrosis is developing and reduce the chance of further damage.

When should I see a liver specialist?

Finding “fatty liver” on a scan does not necessarily mean you need complex treatment.

However, specialist assessment may be useful if you have abnormal liver tests, evidence of fibrosis or cirrhosis, diabetes together with fatty liver, unexplained or worsening liver abnormalities, or uncertainty about how advanced the condition is.

You should also seek medical assessment if you develop symptoms such as yellowing of the eyes or skin, swelling of the abdomen or legs, vomiting blood, black stools or new confusion. These are not typical symptoms of simple fatty liver and can indicate advanced liver disease.

Perhaps the most useful approach is this: don’t wait for your liver to hurt before paying attention to it.

Fatty liver often gives very little warning. Finding it early — and understanding whether it has begun to cause liver damage — is what makes the difference.

Frequently Asked Questions

Is fatty liver common in Sri Lanka?

Fatty liver appears to be common in Sri Lankan study populations. A study of 2,985 urban adults aged 35–64 found it in 32.6% of participants, while a rural Sri Lankan study reported a prevalence of 18%. These studies should not be interpreted as saying that exactly 1 in 3 people across the entire Sri Lankan population have fatty liver.

Can I have fatty liver and normal liver tests?

Yes. Fatty liver can sometimes be present even when routine liver blood tests are not markedly abnormal. Diagnosis and risk assessment may involve your medical history, blood tests and imaging rather than relying on a single liver enzyme result.

Can a thin person have fatty liver?

Yes. Fatty liver can occur in people who are not overweight. Sri Lankan research has documented fatty liver among lean adults.

Can fatty liver be reversed?

Early fatty liver can often improve significantly when the underlying metabolic factors are addressed. Weight management where appropriate, regular physical activity and good control of diabetes, cholesterol and other risk factors can reduce liver fat and may improve inflammation and fibrosis.

Does fatty liver cause pain?

Most people with fatty liver have no symptoms. Some people may experience discomfort or a dull sensation beneath the ribs on the upper right side of the abdomen, but this is not specific to fatty liver.

Can fatty liver turn into cirrhosis?

It can, but not everyone with fatty liver develops cirrhosis. In some people, fatty liver progresses to inflammation and fibrosis. Advanced fibrosis can eventually become cirrhosis.

Can fatty liver cause liver cancer?

Advanced fatty liver disease, particularly when significant fibrosis or cirrhosis develops, is associated with an increased risk of hepatocellular carcinoma, the most common primary liver cancer. Sri Lankan research has also identified fatty liver-related disease as an increasingly important contributor to liver cancer.

What test tells me whether my fatty liver is serious?

There is no single test for everyone. Doctors may use blood tests, fibrosis scores such as FIB-4, ultrasound and liver elastography/FibroScan to assess whether significant liver scarring is present. Some patients require additional investigations.

About Prof. Thamara Perera

Prof. Thamara Perera, MBBS, MS, FEBS, MD, FRCS, is a Consultant Hepatobiliary and Liver Transplant Surgeon at Kings Hospital Colombo.

He previously served as Lead Consultant in Liver Transplantation at Queen Elizabeth Hospital Birmingham and as a Consultant in Paediatric Transplantation at Birmingham Children’s Hospital. His clinical and research experience spans liver transplantation, complex hepatobiliary surgery and innovations in liver transplantation, including normothermic machine perfusion.

Prof. Perera has been directly involved in more than 1,300 adult and paediatric liver transplant operations during his career.

Medically reviewed by: Prof. Thamara Perera · Last reviewed: September 2026

More about Prof. Thamara Perera

Medical References

Peer-reviewed prevalence studies of fatty liver / MASLD in urban and rural Sri Lankan adult populations.
American Association for the Study of Liver Diseases (AASLD) guidance on weight reduction and fatty liver disease management.
Sri Lankan community cohort research on lean (non-obese) fatty liver disease.
Published research on fatty liver disease as a contributor to chronic liver disease and hepatocellular carcinoma in Sri Lanka.

This article provides general health information and should not be used as a substitute for an individual medical assessment.

Concerned about a fatty liver diagnosis?

A specialist consultation can help explain your results, assess whether fibrosis is present and discuss whether further investigation is needed.

Book a Consultation View Patient Resources →

July 22, 2026