Liver Transplant Leadership

Structured Evaluation. Timed Intervention. Lifelong Graft Strategy.

Dr. Chetan Kalal | DM Hepatology (First DM Hepatologist of Maharashtra)

Transplant Is a Decision of Timing — Not Panic

Most liver transplant referrals happen too late.
Some happen too early.

Both are errors.

Dr. Chetan Kalal provides hepatology-led transplant decision strategy for:

• Decompensated cirrhosis

• Acute-on-chronic liver failure (ACLF)

• Hepatocellular carcinoma within criteria

• Refractory ascites

• Recurrent variceal bleeding

• Recurrent hepatic encephalopathy

• Progressive MELD-Na rise

• Declining functional status

Every case is risk-stratified.
No transplant is advised without modelling survival benefit.

The 5-Stage Transplant Control Framework

1. Physiological Optimization

Before listing:

• Infection control

• Nutritional rebuilding

• Sarcopenia reversal

• Portal hypertension stabilization

• Renal protection

• Metabolic correction

A frail patient is a high-risk transplant.
Optimization is mandatory.

2. Candidacy Determination

Comprehensive evaluation includes:

• MELD-Na assessment

• Cardio-pulmonary clearance

• Frailty scoring

• HCC staging (if present)

• Psychosocial and compliance assessment

The question is not “Can we transplant?”
The question is “Will transplant improve survival?”

3. Living Donor Liver Transplant (LDLT) Strategy

India’s transplant ecosystem is largely LDLT-based.

Evaluation includes:

• ABO compatibility

• CT volumetry

• Vascular mapping

• Donor safety clearance

• Ethical compliance

Donor safety is absolute.
There is zero compromise.

4. Surgical Coordination

Dr. Kalal functions as hepatology lead in coordination with transplant surgeons and critical care teams.

The surgery is one event.
Hepatology oversight spans decades.

5. Post-Transplant Graft Governance

Long-term survival depends on:

• Immunosuppression calibration

• Tacrolimus level precision

• Rejection surveillance

• Infection mitigation

• Renal preservation

• Metabolic risk control

• Malignancy surveillance

Surgery gives a liver.
Hepatology protects it.

Transplant Second Opinion — Strategic Review

Patients seek reassessment when:

• “Immediate transplant required.”

• “You are not eligible.”

• “Cancer excludes you.”

• “MELD too low.”

• “Too old.”

Re-evaluation includes:

• Survival modelling

• Bridge-to-transplant strategies

• HCC downstaging pathways

• Medical salvage possibilities

• Timing recalibration

Not all urgent cases are urgent.
Not all rejected cases are ineligible.

International Transplant Evaluation

Structured virtual transplant consults for patients from:

• United States

• United Kingdom

• United Arab Emirates

• Singapore

• Canada

• Australia

• New Zealand

Includes:

• Full medical record review

• Imaging interpretation

• Transplant eligibility guidance

• India-based transplant pathway coordination

• Long-term aftercare planning

Western India Clinical Base

Primary hepatology practice in Mumbai
Referral network across:

• Navi Mumbai

• Thane

• Nashik

• Nagpur

• Indore

Immediate Evaluation Triggers

Seek transplant review if:

• Ascites requires repeated paracentesis

• Variceal bleed history

• Encephalopathy episodes

• Bilirubin rising trend

• MELD >15

• HCC diagnosis

• ACLF event

• Progressive sarcopenia

Delay directly reduces survival probability.

Positioning Statement

This is hepatology-led transplant strategy.
Not volume-driven surgery.
Not panic-driven listing.

A transplant should be:

• Timed

• Justified

• Optimized

• Protected

Consultation Pathway

🌐 drchetankalal.com
📍 In-person consultations: Mumbai
🌍 Global virtual transplant evaluation available

“When transplant becomes necessary, clarity is critical.”