When is Liver Transplant Needed?
Liver transplantation replaces a diseased, non-functioning liver with a healthy donor liver. It is the only definitive treatment for end-stage liver disease (cirrhosis with decompensation) and selected liver cancers (hepatocellular carcinoma within Milan criteria). With modern surgical techniques and immunosuppression, 5-year survival exceeds 75–80%.
At Dhaara Speciality Hospital, Dr. Srinivas Bojanapu — a trained HPB and Liver Transplant Surgeon — provides comprehensive liver transplant evaluation, pre-transplant optimisation, and coordination with leading transplant centres in Bangalore. Post-transplant follow-up and management are available at our Yelahanka centre.
Indications for Liver Transplant
Decompensated Cirrhosis
- MELD score ≥15
- Refractory ascites
- Spontaneous bacterial peritonitis (recurrent)
- Hepatorenal syndrome
- Hepatic encephalopathy
- Variceal bleeding not controlled endoscopically
Specific Conditions
- Hepatocellular carcinoma (HCC) within Milan criteria
- Acute liver failure (fulminant)
- Primary biliary cholangitis (PBC) — end stage
- Primary sclerosing cholangitis (PSC) — end stage
- Wilson's disease
- Autoimmune hepatitis — severe
- Metabolic liver diseases (NASH cirrhosis)
Understanding the MELD Score
The MELD (Model for End-Stage Liver Disease) score predicts 90-day mortality in cirrhotic patients. It is calculated from bilirubin, creatinine, and INR (blood clotting).
| MELD Score | 3-Month Mortality | Action |
|---|
| <10 | <2% | Close monitoring; transplant not urgent |
| 10–18 | 4–12% | Transplant evaluation should begin |
| 19–24 | 20–25% | Active transplant listing recommended |
| 25–30 | 30–50% | Priority listing; urgent optimisation |
| >30 | >50% | Urgent; consider ICU-level care |
Types of Liver Transplant
Deceased Donor Liver Transplantation (DDLT): Liver from a brain-dead donor. Waiting time depends on blood group, MELD score, and organ availability through ZTCC (Zonal Transplant Coordination Centre). Karnataka has a reasonably active deceased donor programme.
Living Donor Liver Transplantation (LDLT): A living donor (typically a family member) donates the right or left lobe of their liver. Both donor and recipient livers regenerate. Advantages: shorter wait time, planned surgery, better outcomes. Donor must be 18–50 years, compatible blood group, BMI <30, healthy. LDLT is more common in India than DDLT.
Our Pre-Transplant Evaluation Services
- Comprehensive hepatology workup (LFT, CBC, coagulation, AFP, viral markers)
- MELD score calculation and tracking
- Cross-sectional imaging (CT/MRI triple phase for HCC assessment)
- Endoscopy (variceal assessment, band ligation)
- Cardiac evaluation (echocardiography, stress testing)
- Pulmonary function tests
- Renal function evaluation
- Psychosocial assessment and transplant counselling
- Nutritional optimisation
- Living donor evaluation support
- Coordination with ZTCC and transplant hospital
Complications of Cirrhosis We Manage Pre-Transplant
Optimising the patient's condition before transplant significantly improves surgical outcomes:
- Ascites management (diuretics, paracentesis, TIPS evaluation)
- Variceal band ligation and beta-blocker prophylaxis
- Encephalopathy management (lactulose, rifaximin)
- Nutritional supplementation and BCAA therapy
- Infection prevention and management (SBP, UTI)
- Renal protection (avoiding nephrotoxic drugs, IV albumin)
Post-Transplant Care at Dhaara
After transplant at a referral centre, we provide ongoing follow-up at our Yelahanka clinic:
- Immunosuppression monitoring and dose adjustments (Tacrolimus, Mycophenolate, Prednisolone)
- Rejection surveillance with liver biopsies when indicated
- Infection monitoring and prophylaxis
- HCC surveillance (CT/AFP) in transplant recipients with prior HCC
- Metabolic complications management (PTDM, hypertension, dyslipidaemia)
- Long-term bone health and nephroprotection
Frequently Asked Questions
How long is the waiting time for a liver transplant in Bangalore?
DDLT (deceased donor) waiting time in Karnataka is typically 6–24 months and depends heavily on MELD score and blood group. Blood group O patients wait longer. LDLT (living donor) has no waiting time once the donor is evaluated and approved — surgery can proceed within weeks of listing.
Is the liver donor at risk?
Living liver donation is a major surgery with risks. Donor mortality is approximately 0.1–0.5% for right lobe donation. Major complication rate is 10–15%. The liver regenerates completely within 6–8 weeks. Donors require thorough medical, psychological, and imaging evaluation to ensure safety.
What is the cost of liver transplant in Bangalore?
Total cost of liver transplant (including surgery, ICU, immunosuppression for 1 year): ₹20–35 lakhs at leading Bangalore centres. Living donor transplants include evaluation and surgery costs for both donor and recipient. Many insurance plans and government schemes (Ayushman Bharat, Karnataka Arogya Karnataka) cover liver transplantation. We assist with documentation and pre-authorization.