Cirrhosis Liver Transplant Treatment & Sympoms | GetWellGo

Cirrhosis Liver Transplant Eligibility​

Liver transplant candidacy for cirrhosis is based on various medical and non-medical factors. Here's the summary:

Medical Criteria:

Severity of Cirrhosis (MELD Score)

• The Model for End-Stage Liver Disease (MELD) score determines priority for transplant.
• A score greater than 15–20 is generally preferred for transplant.
• The score is calculated from laboratory results (bilirubin, creatinine, INR, and sodium).

Complications of Cirrhosis

• Uncontrolled ascites (fluid accumulation in the abdomen).
• Hepatic encephalopathy (confusion due to liver failure).
• Variceal bleeding (severe internal bleeding from engorged veins).
• Hepatorenal syndrome (kidney failure secondary to liver disease).

Liver Cancer (HCC - Hepatocellular Carcinoma)

• Small liver tumors in patients (Milan Criteria) may be eligible.
• Larger tumors may require bridging therapy before listing.

Alcohol and Substance Use

• Patients with cirrhosis due to alcohol must typically show 6+ months of abstinence and completion of counselling.

Absence of Severe Coexisting Conditions

• Severe heart, lung, or uncontrolled infections can render a patient ineligible.

Non-Medical Criteria:

Age Limit

• No fixed age cut-off, but those above 70 years are assessed on an individual basis.

General Physical Condition

• The patient must be healthy enough for surgery and recovery after transplantation.

Social Support and Finances

• Support system for post-transplantation care (family or caregivers).
• Ability to pay for medication and follow-up (insurance or aid programs may be required).

No Active Cancers or Infections (Outside of Liver)

• Those with uncontrolled infections or metastatic cancer are usually not qualified.

Liver Transplant Criteria for Cirrhosis​

• The following are the routine liver transplant criteria for cirrhosis, according to medical guidelines and transplant center protocols:
• Confirmed Diagnosis of End-Stage Liver Disease
• High MELD Score (Model for End-Stage Liver Disease)
• Presence of Cirrhosis-Related Complications
• Absence of Contraindications
• Good Physical Condition (Surgical Fitness)
• Psychosocial Evaluation
• 6 Months of Abstinence (if Alcoholic Cirrhosis)

Cirrhosis Liver Transplant Survival Rate​

• The survival rate after liver transplant for cirrhosis is generally good, especially with modern surgical techniques, post-operative care, and medication. Here's a breakdown of the Cirrhosis Liver Transplant Prognosis:

Liver Transplant Waiting List for Cirrhosis Patients​

The waiting list for liver transplant in patients with cirrhosis is maintained on a national or regional basis in most nations and is prioritized according to urgency, and not by the order of listing.

How the Waiting List Operates for Cirrhosis Patients

• MELD Score-Based Priority
• The Model for End-Stage Liver Disease (MELD) score is the major consideration.
• Higher MELD = More priority since it reflects growing risk of death if not transplanted.
• MELD score is re-calculate every 1–3 months or more urgently if the condition becomes worse.
• Exceptions to MELD Priority

Exception points may be awarded to some patients, including:

Hepatocellular carcinoma (HCC) within Milan criteria

Uncommon liver diseases not fully represented by MELD (e.g., primary sclerosing cholangitis)

• Average Wait Time
• Ranges widely depending on:
• In India
• Few days to >6 months (depending on state registry and availability)

Factors Affecting Cost of Liver Transplant for Cirrhosis​

The cost of a liver transplant for cirrhosis can vary significantly depending on several medical, logistical, and regional factors. Here's a breakdown of what affects the total cost:

Country & Hospital

Type of Donor

• Hospital Stay Duration
• Pre-Transplant Evaluation
• Post-Transplant Medication
• Follow-up & Lab Monitoring
• Complications or Re-Admission

Cirrhosis Liver Transplant Recovery Time​

Recovery duration after liver transplant for cirrhosis is unique to each person, but this is a general framework to provide you with a clear understanding:

Recovery Timeline for Liver Transplant

• Hospital Stay: 2–3 Weeks
• ICU: 2–7 days of close monitoring
• General ward: 7–14 days post-ICU
• Priorities: pain control, infection avoidance, early ambulation, initiation of oral diet
• First 3 Months: Important Phase of Healing
• Multiple follow-ups and lab tests (weekly or every two weeks)
• Started on immunosuppressants to avoid organ rejection
• Low energy levels; skip crowds, raw foods, or heavy activity
• 3–6 Months: Functional Recovery
• Most patients do much better
• Can go back to light duty or work at home
• Liver function levels normalize with meds
• Changes in immunosuppressives are inevitable
• 6–12 Months: Full Recovery
• Get back to regular routine
• Most resume work or schooling at about 6–9 months

Continued monthly appointments

Dietary and lifestyle modifications (no alcohol, wholesome food, reduced sodium)

Factors that Improve Liver Transplant Success Rate in Cirrhosis Patients​

• Early transplant prior to severe multi-organ damage
• MELD score <35 at time of transplant
• Good family or caregiver support
• Living donor transplant (planned, shorter wait times)
• Good post-op care & immunosuppressant adherence

Cirrhosis Liver Transplant Complications​

Liver transplant for cirrhosis can be life-saving, but it comes with risks. Here's a complete list of liver transplant surgery risks for cirrhosis, divided by time frame and type:

• Bleeding
• Infections
• Vascular Complications
• Bile Duct Issues
• Acute Rejection
• Graft Dysfunction or Failure
• Kidney Dysfunction
• Respiratory Problems
• Chronic Rejection
• Recurrent Liver Disease
• Diabetes or High Blood Pressure
• Cancer Risk
• Psychosocial Issues

Liver Transplant Procedure for Cirrhosis​

• Listing and Evaluation
• Complete medical evaluation (imaging, blood tests, heart/lung function)
• Psychosocial and financial evaluation
• Patient listed on the transplant register (according to MELD score or with a living donor match)
• Donor Identification
• Deceased Donor: Patient is contacted when an available matching liver is found
• Living Donor: Healthy volunteer who donates a portion of their liver (usually a family member or close friend)
• Liver regenerates in both donor and recipient within weeks
• Pre-Surgery Preparation
• Hospital admission (usually urgent for deceased donor)
• Blood type cross-matching and final imaging

Fasting before surgery

Consent and anaesthesia assessment

• Transplant Surgery (6–12 Hours)
• Steps:
• Removal of the diseased liver
• May be complicated in cirrhosis due to scar tissue and risk of bleeding
• Implantation of the new liver
• Blood vessels (hepatic artery, portal vein) and bile ducts are joined
• Check blood flow and bile drainage
• Closure of incision and transfer to ICU
• Postoperative Care (ICU and Hospital Stay)
• ICU stay: 2–7 days of observation
• Total hospital stay: 2–3 weeks
• Started on immunosuppressive medications to avoid rejection
• Long-Term Follow-Up
• Weekly → Monthly → Yearly follow-up interval
• Regular monitoring of:
• Liver function (LFTs)

Kidney function

Signs of rejection or infection

Post-Liver Transplant Care for Cirrhosis Patients​

Post-transplant care of cirrhosis patients after liver transplant is strictly necessary to achieve long-term survival, graft function, and overall quality of life. Here is a comprehensive guide:

Medication Management

• Immunosuppressants (life-long):
• Tacrolimus (Prograf)
• Mycophenolate mofetil
• Prednisolone (usually tapered)
• Take meds as scheduled, daily to avoid rejection.
• Monitor side effects: tremors, infections, kidney problems, high BP.

Follow-Up Schedule

• Weeks 1–4: 1–2 visits a week (labs, medication titration)
• 1–3 Months: Monthly or bimonthly visits
• 3–12 Months: Monthly
• After 1 Year: Every 3–6 months, then annually

Diet & Nutrition

• Well-balanced diet with plenty of:
• Lean protein
• Fresh fruits (washed)
• Whole grains

Infection Prevention

• Practice good hygiene
• Stay away from crowded places in early months
• Use mask and hand sanitizer when out
• Vaccines: flu, pneumonia, hepatitis A & B (as recommended)

Physical Activity

• Start with gentle walking
• Gradually build up activity over 3–6 months
• Avoid heavy lifting or strenuous exercise early on

Monitor for Complications

• Call the doctor if any of these happen:
• Fever >100.4°F (38°C)
• Yellowing of skin/eyes
• Dark or light stool
• Dark urine or pale stool
• Pain or swelling in the abdomen
• Disorientation or confusion

Mental Health & Support

• Some patients experience anxiety, depression, or PTSD
• Consult with a counsellor or participate in transplant support groups
• Engage family or caregiver in recovery plan

Lifestyle Changes

• Stop smoking or alcohol forever
• Be healthy weight
• Regulate blood sugar and BP
• Avoid non-prescription medications (particularly NSAIDs) when not necessary

Liver Transplant Hospitals Specializing in Cirrhosis

• Apollo Hospital, Delhi
• Fortis Memorial Research Institute, Gurgaon
• Medanta-The Medicity, Gurgaon
• Artemis Hospital, Gurgaon