Liver Transplant after cirrhosis – When is the right time?


Cirrhosis is end stage damage to liver. It means from the soft smooth liver like a sponge, it has become hard and irregular like a bark of a tree. Once an individual develops cirrhosis of liver, the process is irreversible. The disease progresses gradually over a period. Initially if we find the cause of cirrhosis, we can treat and stabilize the liver for a prolonged period. Eventually however, different complications set in. Initially these complications are manageable with medications and dietary restrictions. However, as the disease worsens, complications persist or recur and that is when doctors’advice you to undergo liver transplant.

Most common causes of cirrhosis in adults in India

1.  Alcohol
2. Fatty Liver
3. Hepatitis B
4. Hepatitis C
5. Drug Induced Liver Injury
6. Autoimmune Hepatitis
7. Wilson’s Disease

The treating#Hepatologist will look for these causes once you are diagnosed with cirrhosis. For Alcohol related cirrhosis, stopping alcohol is of paramount importance. For attyliver related cirrhosis, weight loss is stressed upon. Hepatitis B, Hepatitis C, Autoimmune Hepatitis and Wilson’s disease, there are specific drugs which your doctor will start. Stopping complementary and alternative medicines as well as all herbal products is recommended.

Complications of cirrhosis

Complications develop 2-5 years after development of cirrhosis. There is no fixed sequence of development of all these complications and not all patients will have all of these.There are nearly 500 functions of liver and liver damage worsens, different functions are affected differently. The complications are broadly divided into following

Portal Hypertension – Complications developing because the blood flow through the hardened liver is hampered, and blood flow is reversed.Ascites (Fluid accumulation in tummy)

Edema feet (Swelling of feet)

Low Platelets (Splenomegaly)

Hematemesis (Blood Vomitus)

Malena (Black Stools)

Liver Cell Failure – These complications develop as liver fails to produce necessary substances or clear toxins from the body

Jaundice (Yellow eyes, yellow urine)

Coagulopathy (Increased Bleeding tendencies)

Hypoalbuminemia (Fall in Albumin level)

Encephalopathy (Altered mental state)

Sarcopenia (Loss of muscle mass)


The complications that are caused by portal hypertension can be initially managed and controlled by medicines and endoscopy. These would give you some time to prepare for transplant. Once they develop, you should start asking your #Hepatologist about transplant. Also start reading about it. You Need to decide on the centre where you will approach once the liver functions start worsening.Get finances sorted. If possible, inquire within the family if someone will come forward to donate.

The other complications are caused by liver cell failure. Once you develop these, it is the right time to get a transplant. You should be now in a transplant centre. Although with good medical care, we can still delay for few weeks, but it should not be delayed much as you may cross the transplant window and may not remain transplantable in future.

Acute on chronic Liver Failure

This happens very often. After development of cirrhosis, you may still be living normally on only few medicines. However, any insult to liver which can be anything from a routine viral infection, alcohol, drugs, painkillers, herbal supplements, alternative medicines, infections, clogging of blood supply to liver and liver cancer. This is an urgency as it can rapidly progress to multi organ failure and patients do not make it to transplant.The target should be to avoid any such insults to liver and even if it develops, to transplant before multi organ failure sets in.

A line diagram below indicates how liver function deteriorates over time



If you suffer from cirrhosis and need guidance on liver transplant, please consult your hepatologist.

Make an appointment 

Zydus Hospitals Road, Nr. Sola Bridge, S.G. Highway, Ahmedabad, Gujarat 380054

Contact number : +91 86521 19730









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