Liver Transplant Program

Advanced Recipient Evaluation, Surgical Coordination & Long-Term Graft Care

Led by Dr. Chetan Kalal – DM Hepatology (First in Maharashtra)

When Is Liver Transplant the Right Decision?

Liver transplant is not a last-minute emergency act.
It is a timed, risk-calculated intervention.

Dr. Chetan Kalal evaluates transplant candidacy in patients with:

• Decompensated cirrhosis

• Acute-on-chronic liver failure (ACLF)

• Hepatocellular carcinoma within transplant criteria

• Refractory ascites

• Recurrent variceal bleeding

• Recurrent hepatic encephalopathy

• MELD score progression

• Chronic liver failure with declining quality of life

The decision is never emotional.
It is score-based, physiology-based, and survival-based.

Structured Transplant Pathway

Phase 1: Advanced Hepatology Stabilization

Before transplant listing, we optimize:

• Ascites control

• Nutritional rehabilitation

• Sarcopenia correction

• Infection screening

• Portal hypertension management

• Renal protection strategy

A weak patient does not survive transplant.
Optimization is non-negotiable.

Phase 2: Recipient Evaluation

Comprehensive assessment includes:

• MELD-Na calculation

• Cardiac clearance

• Pulmonary evaluation

• HCC staging (if applicable)

• Frailty scoring

• Psychosocial evaluation

• Financial counselling pathway

Every transplant candidate is risk-stratified.

Phase 3: Donor Evaluation (Living Donor Pathway)

India predominantly performs living donor liver transplant (LDLT).

Evaluation includes:

• Blood group compatibility

• Liver volumetry

• Vascular anatomy mapping

• Donor fitness screening

• Ethical clearance protocol

Safety of the donor is absolute priority.

Multidisciplinary Coordination

Dr. Kalal functions as the hepatology lead coordinating with:

• Transplant surgeons

• Critical care specialists

• Interventional radiology

• Onco-hepatology teams

• Nutrition & physiotherapy teams

The transplant is one day.
The hepatology oversight is lifelong.

Post-Transplant Authority

Transplant success is not discharge from ICU.
It is 5-year graft survival.

Post-transplant management includes:

• Immunosuppression strategy design

• Tacrolimus monitoring

• Rejection surveillance

• Infection risk mitigation

• Renal function preservation

• Metabolic syndrome control

• Long-term malignancy surveillance

Many centers focus on surgery.
Few focus on lifelong graft protection.

That is where hepatology leadership matters.

Second Opinion for Transplant Decisions

Patients approach for second opinions when:

• “You need transplant immediately.”

• “You are not eligible.”

• “Cancer excludes you.”

• “Your MELD is too low.”

• “You are too old.”

Dr. Kalal re-evaluates:

• Transplant timing

• Alternative medical salvage

• Downstaging options in HCC

• Risk-benefit modelling

• Bridge-to-transplant strategies

Not all urgent transplants are urgent.
Not all rejected patients are ineligible.

International & NRI Transplant Consults

Structured virtual transplant evaluation for patients from:

• United States

• United Kingdom

• United Arab Emirates

• Singapore

• Canada

• Australia

• New Zealand

• Middle East & Europe

Includes:

• Record review

• Imaging reassessment

• Transplant candidacy guidance

• Cost & timeline counselling

• Post-return aftercare planning

Geographic Access – Western India

Primary practice: Mumbai

Access network across:

• Navi Mumbai

• Thane

• Nashik

• Nagpur

• Indore

Who Should Seek Immediate Transplant Evaluation?

Red Flag Indicators:

• Ascites requiring repeated tapping

• Variceal bleed history

• Recurrent encephalopathy

• Bilirubin persistently rising

• HCC diagnosis

• MELD >15

• ACLF episode

• Progressive muscle wasting

Delay reduces survival.

Clinical Positioning Statement

This is not a marketing transplant program.

This is structured hepatology leadership in transplant medicine.

When transplant is inevitable, timing is everything.
When transplant is avoidable, intervention is decisive.

Appointment & Structured Transplant Evaluation

🌐 drchetankalal.com
📍 In-person consults: Mumbai
🌍 Global Virtual Transplant Evaluation Available

“Transplant is not the end of liver disease.
It is the beginning of graft responsibility.”