What happens if my MASLD is more advanced?
MASLD is a common condition where fat builds up in the liver. It is often linked to being overweight and conditions like type 2 diabetes and heart disease.
The information on this page is for:
- Adults with MASLD or at risk of MASLD.
- Family, friends, carers, and healthcare professionals.
MASLD can also affect children and young people. See our information for parents and families.
On this page:
Stage 3 or stage 4 MASLD
If you are diagnosed with stage 3 or stage 4 liver fibrosis, it means there is more scarring (fibrosis) in your liver. This can increase the risk of serious problems, such as cirrhosis, liver failure or liver cancer.
At this stage, you may hear the term metabolic dysfunction-associated steatohepatitis (MASH). This was previously called non-alcohol related steatohepatitis (NASH). This is simply another way that doctors may refer to more advanced liver scarring.
Your healthcare team will talk to you about steps you can take to support your health. This may include eating a healthy, balanced diet, staying physically active, and keeping a healthy weight. For some people, these changes can help slow down or even improve liver damage.
Because the scarring has become more advanced, you may need additional treatment or monitoring to reduce the risk of complications.
Cirrhosis
Stage 4 fibrosis is known as cirrhosis. It means there is permanent scarring (fibrosis) of the liver due to long-term damage. At this stage, you will have care and treatment from hospital specialists. Your doctor will discuss any additional treatments you may need. These can help prevent or manage complications linked with cirrhosis.
Cirrhosis: suh-ROH-siss
There are two main stages of cirrhosis:
Compensated (stable) cirrhosis
This means your liver has permanent scarring (fibrosis) but is still working OK. Your body can cope with the damage, and you may not feel unwell. Many people live for years with compensated cirrhosis.
Decompensated cirrhosis
This means your body struggles with the level of scarring (fibrosis) and your liver can’t work properly. You may feel very unwell and have lots of complications. Cirrhosis can change from compensated to decompensated in various ways. However, it’s hard to predict when or if this will happen. This is why regular check-ups are very important.
If you have cirrhosis, you may be offered scans to check for signs of liver cancer every 6 months. This is called surveillance.
How cirrhosis is treated depends on how serious it is and whether you have any complications. Treatment might involve medicines or certain medical procedures to help manage symptoms and prevent further damage.
Symptoms and complications of advanced liver disease
If you are diagnosed with cirrhosis, you may start to experience symptoms and complications. Not everyone gets these complications. But it is a good idea to know what to look out for. They are easier to treat and manage if they are diagnosed quickly.
Complications may include:
Portal hypertension
This happens when pressure builds up in a major vein leading to your liver. It is a complication of liver cirrhosis and can lead to serious issues. Sometimes, portal hypertension can be treated with a surgical procedure. This helps to reduce the pressure.
Ascites
Ascites is when fluid builds up inside your belly (abdomen), causing swelling. It is a complication of decompensated cirrhosis. Most people can be treated with medicines. But some people may need hospital treatment to drain the fluid.
Varices and variceal bleeding
Varices are small veins that are twisted and swollen. They are like the varicose veins that people get in their legs. Varices usually develop in the food pipe (oesophagus) and sometimes in the stomach. Varices can leak or burst, causing serious bleeding known as a variceal bleed. This requires urgent medical attention.
Hepatic encephalopathy (HE)
HE is a brain condition that happens when the liver isn’t working properly. It is a complication of decompensated cirrhosis. It can happen as a sudden emergency or start with very small changes. HE can affect short-term memory and, in some cases, change your personality. For some people, it can be very serious.
Liver cancer (hepatocellular carcinoma, or HCC)
People with MASLD have a higher risk of developing liver cancer. We don’t know the exact level of risk, but in general, the more advanced your MASLD is, the higher your risk will be. The risk is highest for people with cirrhosis.
Liver transplant
The only way to completely cure liver cirrhosis is a liver transplant. This is an operation to remove a damaged liver and replace it with a healthy one from a donor. You may be considered for a liver transplant if:
- your liver isn’t working properly and,
- other treatments cannot help.
This usually happens when the liver is severely damaged and can’t recover.
However, only a small number of people will have a liver transplant. It is also not suitable for everyone. If you have other medical conditions, particularly serious problems with the heart or lungs, or are very unfit, the risk of a transplant may be greater than the benefits. There can also be a long wait for a donor. Your medical team will talk with you about your individual situation. They will help you choose the treatment options that are right for you.
A liver transplant is a major operation, and the recovery process can be long. After the transplant, you will need to take medicines every day for the rest of your life. These medicines help stop your immune system from attacking your new liver.
Most people who have a liver transplant can return to many of their normal daily activities. They can also enjoy long and active lives.
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This content was last reviewed: July 2026
Our expert reviewers:
We would like to thank everyone who helped with creating and reviewing this page. Including Dr Jeremy Cobbold, Consultant Hepatologist, Oxford University Hospitals, Professor Stuart McPherson, Consultant Hepatologist, Newcastle upon Tyne Hospitals and Dr Helen Jarvis, GP, Newcastle University. And all our patient reviewers.
Find out how we make our patient information.
Everyone’s experience of liver disease will be different. Always talk to your specialist medical team for personal advice.
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