The EASL–Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality

Authors: Tom H Karlsen, Nick Sheron, Shira Zelber-Sagi, Patrizia Carrieri, Geoffrey Dusheiko, Elisabetta Bugianesi, Rachel Pryke, Sharon J Hutchinson, Bruno Sangro, Natasha K Martin, Michele Cecchini, Mae Ashworth Dirac, Annalisa Belloni, Miquel Serra-Burriel, Cyriel Y Ponsioen, Brittney Sheena, Alienor Lerouge, Marion Devaux, Nick Scott, Margaret Hellard, Henkjan J Verkade, Ekkehard Sturm, Giulio Marchesini, Hannele Yki-Järvinen, Chris D Byrne, Giovanni Targher, Aviad Tur-Sinai, Damon Barrett, Michael Ninburg, Tatjana Reic, Alison Taylor, Tim Rhodes, Carla Treloar, Claus Petersen, Christoph Schramm, Robert Flisiak, Marieta Y Simonova, Albert Pares, Philip Johnson, Alessandro Cucchetti, Isabel Graupera, Christos Lionis, Elisa Pose, Núria Fabrellas, Ann T Ma, Juan M Mendive, Vincenzo Mazzaferro, Harry Rutter, Helena Cortez-Pinto, Deirdre Kelly, Robyn Burton, Jeffrey V Lazarus, Pere Ginès, Maria Buti, Philip N Newsome, Patrizia Burra, Michael P Manns - The Lancet 2021 cited by 627

1 5 -1 9 2 0 -2 4 2 5 -2 9 3 0 -3 4 3 5 -3 9 4 0 -4 4 4 5 -4 9 5 0 -5 4 5 5 -5 9 6 0 -6 4 6 5 -6 9 7 0 -7 4 7 5 -7 9 8 0 -8 4 8 5 -8 9 9 0 -9 4 9 5 0 2 4 6 8 10 12 14 16 18 100 Percentage of overall deaths (%) 5-year age bands Cancer lung, trachea, bronchus C33-34 Type 2 diabetes E11 Alcohol-related liver disease K70 www.thelancet.com Vol 399 January 1, 2022 those at risk of progression by these final, common pathways of end-stage liver disease has important implications for the simplification of case-finding and patient referral, which should focus on the detection of progressive disease with a high risk of complications. At present, liver disease investigation is dominated by minor blood abnormalities, yet most individuals with such abnormalities will never develop serious disease. However, people with undiagnosed cirrhosis, the majority of whom have normal blood tests, remain undetected; we need to find these people earlier. It often takes a long time to develop liver disease complications, sometimes decades, and this inherent resilience of the liver also means that multiple risk factors acting in synergy should always be considered in progressive liver disease.