Liver Transplant & Advanced Hepatology – Expert FAQ
Dr Chetan Kalal | Mumbai | International Consults
1. When is a liver transplant necessary?
A liver transplant is indicated when liver failure becomes irreversible and life-threatening despite optimal medical therapy.
Common indications include:
Decompensated cirrhosis (ascites, variceal bleed, encephalopathy)
Acute-on-chronic liver failure (ACLF)
MELD score typically ≥15–18
Hepatocellular carcinoma within transplant criteria
Wilson’s disease with liver failure
Autoimmune hepatitis refractory to treatment
The decision is based on MELD score, complication burden, and survival prediction, not symptoms alone.
2. What is the MELD score and why does it matter?
MELD (Model for End-Stage Liver Disease) predicts 3-month mortality risk in advanced liver disease.
It is calculated using:
Bilirubin
INR
Creatinine
Sodium (MELD-Na)
Higher MELD = higher mortality risk.
General reference:
MELD < 10 → usually medical management
MELD 15–20 → transplant evaluation
MELD > 25 → urgent transplant window
MELD is a mortality prediction tool — not a comfort scale.
3. What is the survival rate after liver transplant?
In experienced centers:
1-year survival: ~85–92%
5-year survival: ~70–80%
Outcomes depend on:
Indication
Pre-transplant severity
ICU stability
Donor quality
Post-operative infection control
Early referral improves survival probability.
4. How long does recovery take after liver transplant?
Typical timeline:
ICU: 5–10 days (variable)
Hospital stay: 2–3 weeks
Return to light activity: 6–8 weeks
Functional recovery: 3–6 months
Full metabolic stabilization may take up to 1 year.
5. What is living donor liver transplant (LDLT)?
In LDLT, a healthy donor donates a portion of their liver. The liver regenerates in both donor and recipient.
Advantages:
Planned surgery
Reduced waiting time
Better timing control
Strong survival outcomes in experienced programs
Donor safety is paramount and requires strict evaluation.
6. Can fatty liver (MASLD/NASH) lead to transplant?
Yes.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is now one of the fastest-growing causes of cirrhosis and transplant worldwide.
Warning signs:
Fibrosis stage ≥ F3
Liver stiffness >12–14 kPa
Diabetes + obesity + elevated ALT
Early fibrosis detection prevents transplant.
Late detection leads to transplant.
7. What are the warning signs of liver decompensation?
Urgent signs include:
Ascites (abdominal swelling)
Recurrent vomiting blood
Confusion (encephalopathy)
Rapid jaundice worsening
Kidney dysfunction
Severe muscle loss (sarcopenia)
These indicate high short-term mortality risk.
8. How much does a liver transplant cost in India?
India offers cost-efficient transplant pathways compared to US/UK systems.
Cost varies depending on:
Hospital
ICU duration
Complications
Donor evaluation
Length of stay
International patients should request structured cost transparency, including:
Pre-transplant workup
Surgery
ICU
Post-discharge medications
Quality and outcomes matter more than price alone.
9. Can international patients undergo liver transplant in India?
Yes.
International patients commonly seek:
Faster transplant timelines
Living donor pathways
Cost transparency
Structured multidisciplinary systems
A proper international pathway includes:
Pre-arrival documentation review
Transplant eligibility confirmation
Donor parallel screening
Post-transplant remote monitoring coordination
This is medical relocation — not tourism.
10. When should you seek a second opinion in liver disease?
You should seek a structured hepatology second opinion if:
You were told to “wait and watch” despite worsening labs
You have conflicting biopsy reports
You are borderline for transplant listing
You have Wilson’s, AIH, or complex autoimmune disease
You were denied transplant without clarity
A second opinion should provide:
Staging
Risk prediction
Defined treatment pathway
Transplant timing clarity
Not reassurance — direction.
