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Who needs liver transplantation?

There are international guidelines to follow to decide who need the transplantation of the liver. A person, who suffers from the liver cirrhosis and assessed of less than one year life expectancy are considered for the transplantation of the liver. The liver diseases are graded according to the severity from A to C. All of the grade C patients and most of grade B patients are the eligible candidates for the transplant. Patients having any of the symptoms that are listed below should consult the liver specialists. They can assess the condition of the liver and suggest either drug treatment or transplant, whichever is more suitable to the condition. At any point of time, the better the patient condition, the better would be the surgery results. The results of the liver transplantation would be dismal for the patients, who are malnutrition, critically ill in the ICU and have an active infection or damage to the organs like kidney impairment during the operation. Hence to obtain good results, timely transplant is essential. When the transplant is done timely, which is donated by a good healthy donor liver and the patient being in the normal and reasonable conditions would have 80% of success.

In most of the instances, the causes initially result in treatable Hepatitis usually. If case the offending factor is not treated in time, it would become too late in the course of the disease to be changed and eventually, cirrhosis are developed.

In adults, the most common reason for needing a liver transplant is cirrhosis. Cirrhosis can be caused by many different types of diseases that destroy healthy liver cells and replace them with scar tissue. Generally speaking, any patient suffering from liver cirrhosis who is estimated to have a life expectancy of less than a year or so is a candidate for a liver transplant. The severity of liver disease is graded from A to C on the basis of Child’s scoring or calculated according to a newly devised formula known as the MELD (Model for End-stage Liver Disease) score.

Usually all grade C and most grade B patients are candidates for transplant. In simple words, if the liver fails due to advanced cirrhosis or acute liver failure, liver transplantation is indicated. Some of the common identifiable symptoms of advanced cirrhosis or liver failure are mentioned below. Initially these symptoms can be controlled with medical or endoscopic therapy but occurrence of these complications clearly indicates limited reserve in the liver and one should start planning for liver transplantation at this time.

Indications for Liver Transplant

Acute/Fulminant liver failure

  • Seronegative hepatitis (sporadic non A non B hepatitis)
  • Drugs (paracetamol, isoniazid)
  • Viral (hepatitis B)
  • Metabolic (neonatal haemochromatosis, Wilson’s disease)

Chronic Liver disease:

  • Viral hepatitis B,C
  • Autoimmune hepatitis
  • Cholestatic disorders (Primary Sclerosing Cirrhosis, Primary Biliary Cirrhosis,Extrahepatic biliary atresia)
  • Alcoholic liver disease (ALD)
  • Budd-Chiari syndrome, veno-occlusive disease
  • Non alcoholic steatohepatitis (NASH)
  • Cryptogenic cirrhosis


  • Hepatocellular Carcinoma
  • Primary Neuro-endocrine tumour

Metabolic disorders:

  • Wilson’s disease
  • Hemochromatosis
  • alpha-1 antitrypsin deficiency
  • Primary Oxalosis, Familial Amyloid polyneuropathy
  • Crigler – Najjar syndrome Type I


  • Polycystic liver disease

Symptoms of liver failure due to cirrhosis

  • Jaundice (yellowing of the eyes and skin)
  • Ascites (an abnormal collection of fluid in the tummy)
  • Haematemesis (vomiting of blood)
  • Edema (swelling of legs, feet)
  • Encephalopathy (forgetfulness, drowsiness, mental confusion, incoherent speech or coma)
  • Itching (sensation of immense scratching)
  • Dark yellow coloured urine
  • Fatigue (weakness and loss of vigour)
  • Insomnia (inability to sleep)
  • Tendency to bleed and bruise easily (due to raised INR)
  • Spider naevi (Red spots over body)
  • Redness of hands
  • Smaller testes
  • Gynaecomastia (Larger breasts in males)

Dr Naimish Mehta has performed over 725 liver transplantation surgeries considered to be best liver transplant surgeon in India. Dr. Naimish Mehta is the Lead HPB and Liver Transplant Surgeon, in the Deptt of Surgical Gastroenterology & Liver Transplant Unit I, Sir Ganga Ram Hospital, New Delhi. He has 14 years of experience in the field of Hepato- Pancreatico-Biliary (HPB) Surgery performing complex operations on the Liver, Bile Ducts and Pancreas.