Globally, nearly half of deaths from cirrhosis and chronic liver diseases (CLD) and three-quarters of deaths from hepatocellular carcinoma (HCC) occur in the Asia-Pacific region. Chronic hepatitis B is responsible for the vast majority of liver-related deaths in the region. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common form of CLD, affecting an estimated 30% of the adult population. Compared with people of European descent, people from the Asia-Pacific region carry more genetic variants associated with MASLD and its progression. Alcohol is a fast-growing cause of CLD and HCC in Asia as a result of the rising per-capita consumption of alcohol. Drug-induced liver injury is under-recognized and probably has a high prevalence in this region. The epidemiological and outcome data of acute-on-chronic liver failure are heterogeneous, and non-unified definitions across regions contribute to this heterogeneity. CLDs are severely underdiagnosed, and effective treatments and vaccinations are underutilized. In this Review, we highlight trends in the burden of CLD and HCC in the Asia-Pacific region and discuss the rapidly changing aetiologies of liver disease. We examine the multiple gaps in the care cascade and propose mitigating strategies and future directions.

在全球范围内，近一半的肝硬化和慢性肝病 （CLD） 死亡以及四分之三的肝细胞癌 （HCC） 死亡发生在亚太地区。慢性乙型肝炎是该地区绝大多数肝脏相关死亡的原因。代谢功能障碍相关脂肪性肝病 （MASLD） 是最常见的 CLD 形式，估计影响 30% 的成年人口。与欧洲血统的人相比，来自亚太地区的人携带更多与 MASLD 及其进展相关的遗传变异。由于人均酒精消费量的增加，酒精是亚洲 CLD 和 HCC 的一个快速增长的原因。药物性肝损伤尚未得到充分认识，并且在该地区可能患病率很高。慢加急性肝衰竭的流行病学和结局数据具有异质性，不同地区的定义不一致导致了这种异质性。CLD 被严重诊断不足，有效的治疗和疫苗接种没有得到充分利用。在本综述中，我们强调了亚太地区 CLD 和 HCC 负担的趋势，并讨论了快速变化的肝病病因。我们研究了护理级联中的多个差距，并提出了缓解策略和未来方向。