Obesity and Diabetes Driving Increase in Liver Transplant Cases in Singapore

Singapore General Hospital (SGH) is observing a significant trend shift in liver transplant patient demographics. Metabolic risk factors, including obesity and Type 2 diabetes, are increasingly cited as the primary causes of liver cirrhosis requiring transplantation, whereas previously, viral hepatitis infections were the dominant factor.

Data from nearly 1,200 cirrhosis patients within SingHealth's Chronic Liver Disease Registry indicates that metabolic dysfunction-associated steatohepatitis (MASH), a severe form of fatty liver disease, has emerged as the leading cause of cirrhosis. In 2015, hepatitis B accounted for 63.3% of cases, with MASH at just 1.8%. By 2024, MASH cases had risen to 39.8%, while hepatitis B-related cases dropped to 23.5%.

Professor Brian Goh, director of the SingHealth Liver Transplant Programme at SGH, stated that this trend is reflected in recent transplant referral patterns and aligns with global observations, particularly in developed Western countries experiencing epidemics of obesity and Type 2 diabetes.

An example of this emerging patient profile is Madam Lian Pooh Kim, 60, who received a liver transplant in 2024 due to advanced cirrhosis. Her condition stemmed from Type 2 diabetes and hypertension, with initial signs of insulin resistance appearing during her pregnancies.

This shift underscores the growing public health challenge posed by metabolic diseases and highlights the critical need for preventative strategies focused on lifestyle modifications and management of conditions like diabetes and obesity to reduce the burden on liver transplant services.