Juan and Gisela Silva have a lot to smile about these days.

One reason why, they are back to enjoying home-cooked meals together.

"Oh man, I can eat more now," says Juan. "Before I didn't want to eat anything because it would mess up my stomach and stuff because something wasn't working right."

That led Juan to his doctor's office where a series of tests revealed he had late-stage liver disease.

Watch: The silent liver disease that's on the rise among Hispanics and children

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Nonalcoholic fatty liver disease (NAFLD)

"They told me I had liver cirrhosis," says Juan. "Nobody has ever told me that. They also said I needed a liver transplant, and quick."

Cirrhosis is often caused by long-term, chronic use of alcohol. However, like in Juan's case, people who consume little, or even no alcohol, can develop cirrhosis. Many, like Juan, unknowingly live with a condition called nonalcoholic fatty liver disease (NAFLD), which can lead to a more severe, aggressive condition called nonalcoholic steatohepatitis (NASH). In patients with NASH, the liver becomes inflamed and can progress to advanced scarring (cirrhosis) and liver failure. "I was never a big drinker," says Juan. "Maybe I would have a beer every once in a while. This came as such a surprise to me. I never expected this."

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world. NAFLD is a buildup of extra fat in the liver that is not caused by alcohol use. In the U.S. alone, approximately 75-100 million people, are affected by NAFLD, and rates are rising. Among those most impacted, according to experts, are people like Juan, who are Hispanic.

"We know that Hispanics have a genetic predisposition to develop fatty liver disease, specifically people from Mexico, compared to other countries from Latin America," says Dr. Blanca Lizaola-Mayo, medical director of the Liver Transplant Center in Arizona. "There is a report of 48% of the U.S. Hispanic population that has fatty liver disease, meaning that almost half of the Hispanics who live in the United States have metabolic syndrome and fatty liver disease, and many of them don't even know that they have it."

The silent disease

Nonalcoholic fatty liver disease is referred to as a "silent disease" because often there are no symptoms. However, as the disease progresses, symptoms may include feeling weak, loss of appetite, and nausea. Juan admits to experiencing some of these symptoms but didn't think it was anything serious. "Sometimes I would feel tired and sleep a lot," says Juan. "I could only eat a little bit. Eventually, I just wasn't feeling myself anymore."

NAFLD is also on the rise among children. It is currently the most common liver disease in children in the U.S., affecting an estimated 8 million children and adolescents. Risk factors include obesity, high cholesterol, insulin resistance, and high blood sugar levels. "We believe that this is related to the lack of exercise and physical activity," says Dr. Lizaola-Mayo. "We're seeing more kids watching TV, playing video games, instead of being outside playing. And also their diet is super important."

Prevention

To protect against nonalcoholic fatty liver disease, experts recommend maintaining a healthy weight, eating a healthy diet, and getting regular exercise. Risk factors include obesity, high cholesterol, diabetes and high blood pressure. Experts say if caught early, lifestyle changes alone can control or even reverse the fat buildup in the liver. A blood test at your doctor's office to check liver enzyme levels can help determine your risk level. Further testing may be needed to determine your diagnosis.

Juan ended up getting a liver transplant. Now he's feeling great. He and Gisela are sticking to a healthy diet, including lots of fruits and vegetables. Juan is grateful his disease was caught in time, and also for the donor who gave him the gift of life.

"I want to thank them. I am thankful that people donate," says Juan. "I'm a donor, too. It would be great for people to accept and to donate their organs, and I want to thank the family for doing it."

Related articles:

• The rising tide of nonalcoholic fatty liver disease
• Mayo Clinic Q and A: How to manage symptoms of liver disease
• Mayo Clinic Minute: Why more liver donors are needed
• Mayo Clinic Minute: ‘Liver in a box’ is saving lives with new technology

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That's according to a recent review published in The New England Journal of Medicine. It showed that the five-year survival rate of transplant recipients who received a deceased donor kidney increased from 66% in 1996–1999 to 78% in 2012–2015. And for patients who received a kidney from a living donor, that number improved from 79.5% to 88%.

What's behind the better outcomes?

Watch: The Mayo Clinic Minute

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Long-term survival rates for kidney transplant patients have improved over the past three decades. 

"Significant advances have been made specifically in the detection of antibodies toward kidney transplants. The testing has become much more sensitive, and so now we're able to avoid transplants that may lead to an early rejection," says Dr. Carrie Schinstock, medical director of the Kidney Transplant Program at Mayo Clinic in Rochester, Minnesota.

"There have also been significant advances in different immunosuppression and advances in our ability to detect viruses that can be detrimental to kidney transplant patients."

She says another factor has been the improvement at Mayo in posttransplant management of hypertension, hyperlipidemia, diabetes and obesity that can lead to cardiovascular death.

"We now have protocols in place for weight management posttransplant, and also to implement bariatric surgery pre- and posttransplant with the hope of improving long-term outcomes," says Dr. Schinstock.

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Salmonella infection
Salmonella infection usually is caused by eating raw or undercooked meat, poultry, eggs or egg products. The incubation period ranges from several hours to two days. Typically, people with salmonella infection have no symptoms. Others develop diarrhea, fever and abdominal cramps within eight to 72 hours. Most healthy people recover within a few days without specific treatment. In some cases, the diarrhea associated with salmonella infection and the resulting dehydration can require prompt medical attention. Life-threatening complications also may develop if the infection spreads beyond your intestines. Learn how to reduce your risk of salmonella infection.

EXPERT ANSWERS
Is endometriosis possible after menopause?
The hormone estrogen likely contributes to endometriosis. Once you reach menopause, your body produces little estrogen, so experiencing endometriosis after menopause is rare. Some women continue to experience endometriosis symptoms after menopause, though, and there have been reports of women diagnosed with endometriosis after menopause without prior symptoms. Learn more from Dr. Sandhya Pruthi, a Mayo Clinic general internal medicine physician.

What are the symptoms of a hypertensive crisis?
A hypertensive crisis is a severe increase in blood pressure that can lead to a stroke. Signs and symptoms of a hypertensive crisis that may be life-threatening include severe chest pain; severe headache, accompanied by confusion and blurred vision; nausea and vomiting; and shortness of breath. Learn more from Dr. Sheldon Sheps, an emeritus Mayo Clinic hypertension and peripheral vascular diseases specialist.

PLUS ADDITIONAL HIGHLIGHTS
Weight-loss goals: Set yourself up for success
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Video: 'Organ transplant in highly sensitized patients'

HEALTHY RECIPES
6-grain hot cereal
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Mediterranean-style grilled salmon

HEALTH TIP OF THE WEEK
Use sunblock to avoid cold sores
No one likes cold sores. These tingling, red lip blisters are tough to hide, and sometimes they're slow to heal. You can help prevent them by applying sunblock on your lips and face year-round. Avoid kissing anyone who has a cold sore, and don't share utensils, lip balm, towels or other personal items.

Need practical advice on diet and exercise? Want creative solutions for stress and other lifestyle issues? Discover more healthy lifestyle topics at mayoclinic.org.

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Did you know that one organ donor can save up to eight lives? That’s a pretty powerful reason to consider registering as an organ donor.

More than 118,000 Americans are on the national organ transplant waiting list awaiting a life-saving transplant. Every 10 minutes, someone is added to the national transplant waiting list. On an average day, 77 people receive organ transplants in the U.S. But thousands more never get the call from their transplant center saying a suitable donor organ — and a second chance at life — has been found.

"Organ donation is a generous and worthwhile decision that can be a life-saving gift to multiple people," says Dr. Burcin Taner, chair of the Department of Transplantation at Mayo Clinic's Florida campus. "Thanks to the availability of donated organs, along with regular blood donations that replenish the blood supply so critical to the transplant process, many people will live who might not otherwise have hope."

Contrary to popular belief, signing a donor card or a box on your driver's license doesn't guarantee that your organs will be donated. The best way to ensure that your wishes are carried out is to inform your family of your desire to donate. Doing this in writing ensures that your wishes will be considered. Hospitals seek consent of next of kin before removing organs. If your family members know you wanted to be a donor, it makes it easier for them to give their consent.

If you have no next of kin or doubt your family will agree to donate your organs, you can assign durable power of attorney to someone who you know will abide by your wishes.

Few medical conditions automatically disqualify you from donating your organs. There's also no cutoff age for organ donation. The decision whether or not to use your organs is based on strict medical criteria — not age. So don't disqualify yourself prematurely if you're an older person considering becoming an organ donor.

Many transplant centers will allow you to be a 'living donor' and donate one of your kidneys to a family member, friend or another person of your choice. You also can donate blood or bone marrow.  Donating blood is simple, something you can do regularly (normally every eight weeks) and is an essential component to the organ donation process. Without an adequate supply of all blood types, transplantation cannot occur.

Remember - April is 'National Donate Life Month', so now is a good time to consider registering as an organ donor. Learn more about organ donation from Mayo Clinic.

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Myth or Matter-of-Fact: The first organ to be transplanted in a human was a kidney, not a heart.

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Medical innovation has helped a Chicago-area woman receive a lifesaving double organ transplant, even after she’d been told it wasn’t an option. Previous surgeries had made her risk of organ rejection too high. Her Mayo Clinic doctors, however, turned her dire situation into an advantage. Here’s Dennis Douda with the Mayo Clinic News Network.

Courtney is working to raise organ donor awareness. Anyone who’d like to wish her well can do so at her Facebook page.

Journalists: The broadcast quality video package and additional b-roll are available in the downloads. Click here to read the full script. 

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PHOENIX — The shortage of kidneys needed for organ transplantation in the U.S. can be alleviated in part by using select kidneys with Acute Kidney Injury (AKI), resulting in safe and positive outcomes, according to research conducted at Mayo Clinic in Arizona.

Results of the single-site study, led by Raymond Heilman, M.D., Chair of the Division of Nephrology, suggest that acutely injured kidneys from deceased donors can be considered for transplantation — reconsidering previous thinking that such kidneys should be discarded.

Kidneys can result in acute injury when the organ ceases to function, generally caused by heavy blood loss, severe infection, extreme dehydration and some medications.  At the same time, according to Dr. Heilman, “The kidney has a remarkable ability to regenerate parts of the organ that weren’t working.”

MEDIA CONTACT: Lynn Closway, Mayo Clinic Public Affairs, 480-301-4337, closway.lynn@mayo.edu

The Mayo research examined the results of 162 kidney transplants, using kidneys from deceased donors with AKI between June 2004 and October 2014.  Deceased donors with AKI whose kidney function was diminished were studied, with 70 percent classified as having severe AKI.  Researchers found that transplant outcomes using kidneys from deceased donors with AKI were no different between the AKI and non-AKI groups at both 1 and 3 years post-transplant.  Results included a comparison of graft survival (how long the kidney would last), kidney function and rejection rates.

“A decade ago we were very selective about using these AKI kidneys because of concern they wouldn’t function well, or the long-term outcomes would be inferior,” says Dr. Heilman. “Over time, however, especially in the past two years, we have found that such stringent criteria are not necessary.” He added that AKI kidneys considered for transplantation are carefully examined by pathologists, surgeons and nephrologists to make sure they are viable.

“With our data and evidence, we are confident that we are not short-changing the recipient by offering these AKI organs for their kidney transplant,” Dr. Heilman says.

He cites the ever-increasing disparity between the number of patients waiting for a kidney transplant and the available donor pool for driving the need to expand the criteria, noting that organs with AKI are one such option.

“Why would transplant surgeons and physicians push the envelope to get creative in using kidneys?” asks Dr. Heilman, explaining, “Because of the dramatic shortage of organs available for transplant.”  He notes that currently, some 100,000 patients in the U.S. are on a wait list for a kidney transplant, and because of the donor shortages, only between 12,000 and 13,000 people are able to receive a transplant per year. It is not uncommon for patients to wait 8 years in some parts of the U.S.  “And the number of people dying on the wait list is increasing,” he says.

“Our data and experience in studying use of AKI kidneys should assure the transplant communities that this results in safe and excellent outcomes,” concludes Dr. Heilman. “If this is adopted across the U.S., we estimate that between 300 and 600 additional kidneys per year would be transplanted.”

The study was published in the March 24 edition of American Journal of Transplantation.

Other Mayo Clinic authors include Maxwell Smith, M.D.; Sunil Kurian, Ph.D.; Janna Huskey, M.D.; Ramesh Batra, MBBS; Harini Chakkera, M.D.; Nitin Katariya, M.D.; Hasan Khamash, M.D.; Adyr Moss, M.D.; Daniel Salomon, M.D. and Kunam Reddy, MBBS.

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