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

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.