Answers
When is a liver transplant needed?
Short answer
A liver transplant is considered when the liver is failing and other treatments can no longer keep a person well. Common reasons are advanced cirrhosis with complications, sudden liver failure, ACLF, and some early liver cancers. In India most transplants use part of a liver from a living family donor, and results are good in carefully selected patients.
Signs that it may be time to discuss transplant
It is best to discuss transplant early, before a crisis, so that evaluation can be done calmly.
- Fluid in the abdomen (ascites) that keeps coming back
- Repeated confusion (hepatic encephalopathy)
- Bleeding from varices
- Persistent or worsening jaundice
- A high MELD score, which combines bilirubin, INR, creatinine and sodium
- Liver cancer within the size limits suitable for transplant
- Sudden liver failure, or ACLF that is not improving
Evaluation
A transplant team checks the heart, lungs, kidneys, infections, nutrition and mental health, and confirms that the person can stay off alcohol and take lifelong medicines. The family's support and a suitable donor are also assessed.
Donors
- Living donor: a healthy family member, usually aged 18 to 55 with a matching blood group, donates part of their liver. Both livers grow back to near-normal size within months.
- Deceased donor: a liver from a brain-dead donor through the state organ sharing system, which depends on waiting list priority.
Life after transplant
Most people return to normal activities within a few months. Anti-rejection medicines are taken for life, with regular blood tests. Staying off alcohol, protecting against infections and keeping follow-up visits are essential.
Dr. Kshitij Lochab assesses patients with advanced liver disease, manages complications, and refers suitable patients to liver transplant centres at the right time.
Food before and after transplant
Eat more
- Before transplant: protein at every meal and a bedtime snack to keep muscle strong
- After transplant: freshly cooked, hot food and boiled or filtered water
- A balanced plate with vegetables and whole grains to control weight, sugar and blood pressure
Cut down
- Salt, if there is fluid in the belly before transplant
- After transplant: raw or undercooked eggs, meat and fish, unpasteurised milk and street food
- Grapefruit and pomelo (chakotra), which interfere with anti-rejection medicines
Good to know
- Anti-rejection medicines lower immunity, so food safety matters for life.
- Weight, sugar and cholesterol often rise after transplant; regular exercise helps.
Common questions
Is a living donor's health at risk?
Donors are tested very carefully, and only those who are fit are accepted. Most return to normal life within a few months, and the remaining liver grows back to near-normal size. There is a small risk, which the transplant team explains in detail.
How long does a transplanted liver last?
Many people live well for 20 years or more after transplant, provided they take their medicines, avoid alcohol and keep follow-up.
When should we start talking about transplant?
Early, when complications such as fluid, confusion or bleeding begin, or when the MELD score rises. Evaluation takes time and is much easier before a crisis.