Top Common Indications for Liver Transplant

Medically Reviewed by Dr. Aman Priya Khanna
Written by Sangeeta Sharma, last updated on 18 December 2023
Top Common Indications for Liver Transplant

Liver transplantation in India had a slow start in the early 2000s, with only 131 surgeries performed by 2004, but the numbers soared to 3713 by 2022. Over the past decade, certain regions saw significant progress. 

Delhi in the north became a centre for Living Donor Liver Transplant (LDLT). While Chennai and Hyderabad in the south excelled in Deceased Donor Liver Transplant (DDLT). Out of approximately 7500 liver transplants in India, about 80% are LDLT, and the remaining are DDLT. 

But what is the most common indication for liver transplant in India? When is the right time to consult a doctor for a liver transplant? Read below to know the answer to the following question.

What is a Liver Transplant?

The liver performs vital bodily functions, including digestion, metabolism, and immune system support. Signs of liver problems may manifest as jaundice, abdominal pain, and unexplained weight loss. 

Recognizing these signs early and understanding liver health helps prevent and manage liver conditions effectively. When the function of the liver is damaged, a liver transplant is recommended.

A liver transplant is a critical procedure that saves lives by replacing a diseased liver with a healthy one. The organ can be donated from a recently deceased person, although a living individual can donate in other cases. 

Since the liver can regenerate, only a portion is taken from a healthy donor during the transplant. The donated section grows into a fully functional liver within six weeks. This ensures both the patient and the donor recover fully, resulting in a healthy life for both.

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Indications of Liver Transplant

When standard medical treatments don't work for severe liver diseases, like cirrhosis, liver transplantation is considered. If patients experience serious complications such as hepatic encephalopathy or variceal haemorrhage, they receive medical care, but those for transplantation undergo an evaluation.

About 80% of liver transplants are done for advanced cirrhosis cases where the liver can't function properly. The severity of cirrhosis is often assessed using the Child-Turcotte-Pugh score. Various factors, like albumin levels and bilirubin levels, are considered. 

Common Indications of Liver Transplant in Adults

  1. Acute Liver Failure: When the liver suddenly stops working, a transplant may be needed to save a person's life, as medications may not be sufficient. There is severe liver damage, which occurs rapidly, leading to hepatic encephalopathy (confusion), bleeding, and other life-threatening complications.

  2. Alcoholic Liver Disease: In cases of advanced liver damage due to long-term alcohol abuse, a transplant may be the only viable option for survival.

  3. Viral Hepatitis: If chronic viral infections like hepatitis B or C lead to severe liver damage or cirrhosis, a transplant may be recommended. It is when antiviral medications fail to control the progression of viral hepatitis, and liver function declines.

  4. Non-alcoholic Fatty Liver: In cases where non-alcoholic fatty liver disease (NAFLD) progresses to cirrhosis and causes liver failure, a transplant may be necessary.

  5. Liver Cancer: If liver cancer reaches an advanced stage or is unresponsive to other treatments, a transplant may be recommended.

Rare Indications of Liver Transplant in Adults

Polycystic Liver Disease: A liver transplant may be considered in rare cases of polycystic liver disease, where extensive cysts impair liver function and cause severe symptoms. The liver results in numerous fluid-filled sacs, leading to pain and complications.

Hereditary Hemochromatosis: It is a genetic disorder causing excessive iron buildup in the liver, leading to organ damage. When iron overload becomes severe, a transplant may be necessary to address the life-threatening consequences.

Familial Amyloid Polyneuropathy (FAP): In cases of FAP, a rare genetic disorder causing abnormal protein accumulation in the liver, transplant may be considered to halt disease progression.

Hepatic Adenomas: In rare cases of hepatic adenomas, noncancerous liver tumours can cause bleeding and other complications. A transplant may be considered if other treatments are ineffective.

Liver Transplant in Children Indications

For children needing a liver transplant, the most common reason is biliary atresia. For metabolic liver conditions, it is Wilson's disease. The indications of paediatric liver transplant are:

  1. Biliary Atresia: A liver transplant may be recommended for infants with biliary atresia, a condition where bile ducts are blocked or absent, leading to liver damage. When kasai procedure to correct the bile duct is not successful, transplant becomes a critical option for children with biliary atresia.

  2. Wilson's Disease: It is a rare genetic disorder causing copper buildup in the liver, leading to organ damage. When medications fail to control copper levels and prevent liver damage, a transplant becomes a potential solution for children with Wilson's disease.

  3. Budd-Chiari Syndrome: In rare cases of Budd-Chiari syndrome in children, where blood flow out of the liver is obstructed, a liver transplant may be recommended to restore normal liver function. Untreated Budd-Chiari syndrome may result in liver failure, potentially causing death within a span of 3 months to 3 years after diagnosis.

  4. Crigler-Najar Syndrome: For children with Crigler-Najar syndrome, a rare genetic disorder causing severe jaundice. It is due to a lack of an enzyme. When conventional treatments are insufficient to manage the excessive bilirubin levels causing jaundice, a transplant becomes a life-changing option for pediatric patients.

  5. Glycogen Storage Disease (GSD):  A rare genetic disorder affecting the storage of glycogen in the liver, leading to organ dysfunction. It results in liver enlargement and impaired function. A liver transplant may be considered for children with glycogen storage diseases for better long-term health outcomes.

Steps to Consult a Liver Transplant Surgeon

Your first step is to get a referral from a liver specialist (hepatologist) who can guide you through the transplant process. This referral is crucial as it ensures that you're directed to the right experts for advice on the necessity of a transplant.

The preliminary evaluation by the transplant team includes:

  1. A thorough medical history assessment to understand the overall health and the specifics of your liver condition.

  2. They will then perform diagnostic tests and imaging to gather detailed information about your liver function and identify potential challenges.

  3. The transplant team will have a detailed conversation with you about the potential benefits of liver transplantation, such as improved quality of life and increased life expectancy.

  4. They will also discuss the associated risks, ensuring you clearly understand both the positive outcomes and potential challenges.

  5. You'll receive comprehensive information about the transplant process, including what to expect before, during, and after the surgery.

  6. Post-transplant care details will also be provided, ensuring you are well informed about the recovery period and the steps needed for a successful recovery.

  7. It is important to seek a second opinion to confirm the necessity of a liver transplant and to explore different perspectives on your condition and potential treatment options. A second opinion helps you make an informed decision and ensures you are comfortable with the recommended action.

Click on Liver Transplant Guide to know the step-by-step procedure of transplant.

Criteria for Considering Liver Transplantation

Deciding to go ahead with a liver transplant involves a thorough evaluation of the causes and stage of liver disease, complications from cirrhosis, potential obstacles, and a detailed psychosocial assessment. 

The criteria of liver transplant depends on the severity of liver disease, measured using the following: 

  1. Model for End-Stage Liver Disease (MELD) Score: The MELD score is a numerical measure that assesses the severity of liver disease. It predicts the three-month mortality of individuals awaiting a transplant based on specific lab values such as creatinine, bilirubin, and INR.

    A higher score indicates a greater need for transplantation. Liver transplant consideration often involves monitoring the MELD score. If it reaches a critical level, indicating advanced liver disease, transplantation becomes a viable option.

  2. Severity of Liver Disease and Complications: The decision for liver transplantation considers the overall severity of liver disease, including factors like cirrhosis and the presence of complications such as ascites or hepatic encephalopathy.

    When liver disease becomes advanced and complications affect daily life, transplantation is contemplated as a means to improve both the quality and duration of life.

Contraindications of Liver Transplant

While liver transplantation is a transformative option for many, certain conditions may limit its feasibility. Understanding these contraindications is crucial for individuals considering this life-changing procedure.

Absolute Contraindications

These conditions or factors completely rule out a specific medical treatment or procedure, making it too risky. These includes:

  1. Active Alcohol Abuse: Ongoing alcohol abuse is an absolute contraindication, as it can jeopardize the success of the transplant and pose additional health risks. People with alcohol addiction should consider seeking psychological and psychiatric support before a liver transplant.
    This precautionary step is crucial to ensure at least six months of alcohol abstinence, mitigating the risk of relapses that might result in removal from the liver transplant waiting list.

  2. Uncontrolled Systemic Infections: Severe, uncontrolled infections affecting the entire body may preclude liver transplantation due to the heightened risk of complications.

  3. Uncontrolled Extrahepatic Malignancy: The presence of uncontrollable cancers outside the liver is an absolute contraindication, ensuring a focus on successful transplantation outcomes.

  4. Existing Medical Conditions: Medical conditions that are uncontrolled or significantly limit overall health may be absolute contraindications. It can include conditions like impaired kidney function. This impacts the feasibility of a successful liver transplant.

Relative Contraindications

These factors may pose some concerns but don't entirely prevent the treatment. It requires careful evaluation of risks and benefits before proceeding. It includes:

  1. Psychosocial Conditions: Certain psychosocial conditions, such as lack of support or coping mechanisms, may be relative contraindications, requiring careful evaluation before considering transplantation.

  2. Advanced Age: While not an absolute barrier, advanced age may be a relative contraindication, considering overall health and the potential impact on post-transplant outcomes.

  3. Severe Hepatopulmonary or Hepatorenal Syndrome: Conditions affecting the lungs (hepatopulmonary syndrome) or kidneys (hepatorenal syndrome) may be relative contraindications, necessitating thorough assessment before transplantation.

  4. Severe Obesity: Extreme obesity may be considered relative contraindications, as they can impact the success of the transplant and subsequent recovery.

Risk of Delay in Liver Transplant

For patients receiving liver transplants from deceased donors, the 1 -year survival rate is 86 per cent. The goal is to identify individuals who may benefit from a liver transplant due to the failure of medical treatments in managing their liver disease.

But, delaying a liver transplant can significantly impact the patient's quality of life, affecting their daily activities and well-being. It can be life-threatening. Untreated liver conditions can have issues like:

  1. Progression of Liver Disease: With time, liver diseases can progress. It potentially reduces the chances of a successful transplant, complicating the surgical process.

  2. Worsening Health Condition: Delaying a liver transplant can lead to a deterioration in the patient's overall health, increasing the risk of complications.

  3. Limited Donor Compatibility: Delay may result in a reduced pool of compatible donors, making it harder to find a suitable match for the transplant.

  4. Impact on Transplant Success: Timely transplantation often results in better outcomes, and delays can affect the overall success rates of liver transplant surgeries.

  5. Longer Recovery Period: The recovery process post-transplant may be prolonged if the surgery is delayed, potentially affecting the patient's return to normal activities and overall recovery experience.

  6. Financial Strain: Extended delays may lead to increased medical expenses, as the patient may require additional treatments or interventions to manage the progressing liver disease.


In India, many people suffer from liver diseases, with 22.2 deaths per 100,000 people linked to cirrhosis, according to the World Health Organization. 

Adults in India face common causes of chronic liver disease, like alcohol-related issues and viral hepatitis. 

Additionally, the rising diabetic population, possibly due to insulin resistance, is making nonalcoholic steatohepatitis a significant concern for liver health in the country. 

We, at HexaHealth are committed to offering high-quality and budget-friendly liver transplant surgeries in India. If you have questions about the procedure, costs, possible side effects, hospital stay, financing options, or post-surgery recovery, don't hesitate to contact us.

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Frequently Asked Questions

What are the indications for liver transplant?

The following are the indications for liver transplant:

  1. Acute liver failure

  2. Chronic liver failure

  3. End-stage liver disease (ESLD)

  4. Hepatocellular carcinoma (Liver cancer)

  5. Biliary atresia

  6. Metabolic disorders

  7. Recurrent infections or complications

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What are the liver transplant indications and contraindications?

Indications for liver transplant are:

  1. Acute and chronic liver failure

  2. End-stage liver disease (ESLD)

  3. Hepatocellular carcinoma

  4. Biliary atresia

Contraindications for liver transplant are:

  1. Advanced cardiovascular disease

  2. Active substance abuse

  3. Advanced age

  4. Untreatable cancer spread

  5. Severe lung disease

  6. Active, unmanageable infections are affecting transplant safety

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What is the most common indication for liver transplant in India?

The primary factors leading to a need for liver transplants in adults are End Stage Liver Disease (ESLD) and cirrhosis. It is commonly triggered by chronic infections like Hepatitis C or Hepatitis B, as well as prolonged alcohol use.

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What are the combined liver-kidney transplant indications?

Combined or sequential liver-kidney transplantation (CLKT/SLKT) is recommended when both the liver and kidneys are failing simultaneously or sequentially.

It's also considered when a patient with kidney failure needs a liver replacement for a specific missing enzyme or when a liver transplant recipient develops kidney failure requiring renal transplantation.

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What are the auxiliary orthotopic liver transplant indications?

Auxiliary liver transplantation emerged as a solution because some patients with acute liver failure meeting transplant criteria can fully recover liver structure and function. Indications for this type of transplantation include conditions like:

  1. Seronegative non-A non-B hepatitis
  2. Drug-induced hepatitis
  3. Autoimmune hepatitis
  4. Mushroom poisoning
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What are the indications for liver transplant in cirrhosis?

If cirrhosis progresses to liver failure, doctors may contemplate a liver transplant as a potential solution. It happens if all treatment options have failed.

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What are the indications for liver transplant in paracetamol overdose?

Immediate medical attention is crucial in cases of paracetamol overdose. Decisions regarding liver transplant is based on the severity of liver damage. It includes:

  1. Severe Liver Damage: When paracetamol overdose leads to critical and irreversible liver damage.

  2. Acute Liver Failure: Rapid onset of severe liver dysfunction due to paracetamol toxicity.

  3. High Paracetamol Levels: Elevated blood levels of paracetamol despite treatment measures.

  4. Development of Complications: Presence of complications, such as bleeding disorders or organ failure.

  5. Inadequate Response to Treatment: When standard treatments fail to improve the condition sufficiently.

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What are the indications for liver transplant in paediatrics?

Most children with the need for a transplant is often determined by organ failure or severe complications. The primary reasons for transplantation in children, ranked from most to least common, include:

    1. Biliary atresia

    2. Inborn errors of metabolism 

    3. Postnecrotic cirrhosis

    4. Cholestasis

    5. Portal hypertension

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What are the domino liver transplant indications?

Domino donors typically provide livers to older adults or those with liver conditions like end-stage liver disease or cancer. If you're in the final stage of liver disease, opting for a liver from a domino donor could shorten your wait time for a deceased donor.

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What are the indications for increasing GGT level in liver transplant patients?

According to the research conducted by Edris M Alkozai, high GGT levels are associated with a higher risk of health problems and cardiovascular death. However, in individuals who have undergone liver transplantation and are doing well, GGT levels are typically elevated.

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What is the indication for liver transplant after variceal bleed?

For certain patients experiencing bleeding from enlarged blood vessels in the liver (varices), liver transplantation is a crucial treatment choice. The indications concerning variceal are as follows:

  1. Recurrent Variceal Bleeding: When there are repeated episodes of severe bleeding from enlarged blood vessels in the liver (varices) despite medical interventions.

  2. Advanced Liver Cirrhosis: Presence of extensive liver scarring and damage, often caused by chronic conditions like liver disease.

  3. Failure of Other Treatments: If measures to control variceal bleeding, such as endoscopic therapy or medications, prove ineffective.

  4. High Risk of Mortality: When the combination of liver cirrhosis and recurrent bleeding poses a significant risk to life.

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What is the indication for liver transplantation in HCC?

Liver transplantation may be considered for those with hepatocellular carcinoma if their tumour is 8 cm or less in diameter. If larger than 8 cm, it should be low-grade (grade I or II) with a preoperative AFP (Alpha-fetoprotein tumour marker) level of 400 ng/mL or less.

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What are the indications for liver transplant in acute liver failure?

The indications of acute liver failure are:

  1. Gastrointestinal bleeding

  2. Hepatorenal syndrome (a condition affecting the liver and kidney)

  3. Persistent fluid accumulation (refractory ascites)

  4. Uncontrolled confusion and neurological issues (portosystemic encephalopathy)

  5. Life expectancy estimated to be less than 7 days

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What are the indications of liver transplantation in pregnancy?

Indications for liver transplantation in pregnancy are:

  1. Acute Liver Failure: Sudden and severe liver dysfunction during pregnancy.

  2. Fulminant Hepatic Failure: Rapid and extensive liver damage jeopardizing both maternal and foetal well-being.

  3. Progressive Liver Disease: Chronic liver conditions pose a significant threat to the woman's health.

  4. Intractable Symptoms: Uncontrolled symptoms, despite medical management, endangering the woman and the unborn child.

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Is cholangiocarcinoma a contraindication for liver transplant?

Cholangiocarcinoma is generally considered a contraindication for a liver transplant due to the high risk of cancer recurrence after transplantation. It has a poor prognosis, and the individuals diagnosed with cholangiocarcinoma typically have a survival of approximately two years.

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All the articles on HexaHealth are supported by verified medically-recognized sources such as; peer-reviewed academic research papers, research institutions, and medical journals. Our medical reviewers also check references of the articles to prioritize accuracy and relevance. Refer to our detailed editorial policy for more information.

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Updated on : 18 December 2023


Dr. Aman Priya Khanna

Dr. Aman Priya Khanna

MBBS, DNB General Surgery, Fellowship in Minimal Access Surgery, FIAGES

12 Years Experience

Dr Aman Priya Khanna is a well-known General Surgeon, Proctologist and Bariatric Surgeon currently associated with HealthFort Clinic, Health First Multispecialty Clinic in Delhi. He has 12 years of experience in General Surgery and worke...View More


Sangeeta Sharma

Sangeeta Sharma

BSc. Biochemistry I MSc. Biochemistry (Oxford College Bangalore)

6 Years Experience

She has extensive experience in content and regulatory writing with reputed organisations like Sun Pharmaceuticals and Innodata. Skilled in SEO and passionate about creating informative and engaging medical conten...View More

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