✓ Bengaluru
✓ ZCCK Registered
✓ ZCCK Registered
Deceased donor and living donor liver transplant with a benchmark one-year outcomes. From first evaluation to lifelong aftercare — Dr. Srinivas Bojanapu, Liver Transplant and HPB Surgeon, Dhaara Liver Clinic, Yelahanka, North Bangalore.
A liver transplant replaces a diseased, failing liver with a healthy liver from a donor. It is the only curative treatment for end-stage liver disease and the only option when the liver can no longer sustain life. The decision to list for transplant is based on disease severity, quality of life, risk of dying without transplant, and transplant eligibility.
MELD (Model for End-stage Liver Disease) is calculated from bilirubin, creatinine, and INR. It predicts 90-day mortality without transplant and drives organ allocation priority.
Liver transplant is not suitable for everyone. Absolute contraindications include:
Dr. Srinivas performs all forms of liver transplantation — adult and paediatric, living and deceased donor.
A healthy family member donates their right lobe (adult to adult) or left lateral segment (adult to child). The donor's liver and the recipient's transplanted lobe both regenerate to full size within 6–8 weeks. Surgery scheduled within 3–6 weeks of completing donor workup — no waiting list.
A whole liver from a brain-dead (DBD) or donation after cardiac death (DCD) donor. Dr. Srinivas is empanelled with ZCCK (Zonal Coordination Committee Karnataka) for government organ allocation. Priority access for high-MELD patients. Waiting time varies — weeks to months based on MELD score.
Children with biliary atresia (the most common paediatric indication), metabolic liver diseases (Crigler-Najjar, Wilson's disease in children), Alagille syndrome, and acute liver failure in children. Left lateral segment from a living adult donor or split-liver from a deceased donor. Specialised paediatric technique and post-operative care.
When a prior transplant fails — from primary non-function, chronic rejection, recurrent disease, or vascular/biliary complications — a second transplant may be required. Re-transplantation is technically demanding with higher surgical risk. It requires experienced HPB surgical judgement to assess feasibility and timing.
Approximately 25–30% of potential donors are rejected after workup — for medical, anatomical, or volumetric reasons. This high rejection rate reflects our rigorous donor safety standards.
Comprehensive assessment: MELD/PELD score, full liver function panel, imaging (triple-phase CT + MRI liver), cardiac evaluation (ECG, echo, stress test), pulmonary function, nutritional assessment, and multidisciplinary transplant team review. Goal: confirm candidacy, identify contraindications, and determine urgency.
LDLT: potential donors undergo blood tests, CT volumetry, MRI biliary anatomy, echocardiogram, psychological evaluation, and ethics committee clearance. Usually completed in 2–3 weeks. DDLT: registration with ZCCK; organ allocation based on MELD score and blood group. Active optimisation of patient's condition while waiting.
Nutrition: high-protein diet, oral supplements, nasogastric feeding if needed. Infection prophylaxis: dental clearance, skin infection treatment, HBV/HCV antiviral optimisation. Bridging therapy for HCC: TACE, RFA, SBRT to control tumour while awaiting transplant. Ascites and encephalopathy control.
The recipient's diseased liver is removed (hepatectomy — often the most difficult part in cirrhotic patients with portal hypertension and adhesions). The donor liver is implanted: hepatic vein anastomosis, portal vein, hepatic artery, and bile duct reconstruction. Dr. Srinivas performs or directly supervises all critical anastomoses.
Daily monitoring: liver function tests (bilirubin, ALT, prothrombin time), bile output, tacrolimus levels, renal function, coagulation. Most patients are extubated within 12–24 hours. Bile production from the drain is the first sign of graft function. Family kept updated daily.
Ward stay: 10–14 days. Immunosuppression established: tacrolimus (target levels adjusted for rejection vs infection risk), mycophenolate, steroid taper. Infection prophylaxis: anti-fungal (fluconazole), anti-viral (valganciclovir), anti-bacterial (cotrimoxazole). Discharge when tolerating food, stable LFTs, and caregiver trained on medications.
Year 1: weekly LFTs for 1 month, then monthly. Tacrolimus level monitoring and dose adjustment. Vaccinations (live vaccines avoided). Year 2+: 3-monthly, then 6-monthly, then annual review. HCC surveillance (if original indication was HCC or HBV/HCV). Metabolic complications monitoring: hypertension, diabetes, dyslipidaemia, renal function, bone density.
Tacrolimus (FK506) is the cornerstone. It prevents the immune system from attacking the new liver. Dose is minimised over years. Side effects at high doses: kidney strain, hypertension, diabetes, tremor. At stable low maintenance doses, most patients feel these minimally. Never stop immunosuppression without your transplant team's guidance — rejection can occur even years later.
First 6 months post-transplant: highest infection risk (bacterial, viral — CMV, EBV, fungal). Standard prophylaxis significantly reduces risk. Vaccinations must be updated (excluding live vaccines). Annual influenza vaccine recommended. Avoid raw foods, unwell contacts, and large crowds in the first 3 months.
Acute cellular rejection: occurs in 15–25% of patients, usually within 3–12 months. Presents as rising LFTs, confirmed by biopsy. Treated with high-dose IV steroids — highly effective. Chronic rejection: rare, insidious. Requires immunosuppression adjustment or re-transplant. Regular LFT monitoring is how rejection is caught early.
No dietary restrictions after 3 months except: avoid grapefruit (interacts with tacrolimus); wash all fruits and vegetables thoroughly; avoid unpasteurised dairy. Exercise: walking encouraged from day 5 post-surgery. Swimming and gym from 3 months. Weight gain is common in the first year (steroids + improved appetite) — dietitian involvement is important.
Desk work: return at 6–8 weeks. Physical work: 3–4 months. Driving: from 6 weeks (when no longer on strong pain medication and cleared by transplant team). Travel: domestic from 3 months, international from 6 months. Carry medications in hand luggage — never in hold baggage. Carry a medical summary letter on all journeys.
Metabolic syndrome (hypertension, diabetes, dyslipidaemia) — driven by tacrolimus and steroids. Annual cardiovascular risk assessment and management. De novo malignancy — immunosuppression increases cancer risk; annual skin check, colonoscopy per guidelines. Bone density — osteoporosis risk; calcium and vitamin D supplementation, DXA scan every 2 years.
Registered with ZCCK (Zonal Coordination Committee Karnataka) — priority access to deceased donor organs under government allocation, reducing waiting time for DDLT candidates.
Systematic peri-operative protocols, dedicated liver ICU care, and meticulous surgical technique — with outcomes tracked against international transplant benchmarks.
Dr. Srinivas is both a transplant surgeon and an HPB surgeon. Complex vascular reconstruction, bile duct variants, re-do surgery, and combined liver-kidney transplant planning all require this dual expertise.
The only dedicated Liver Transplant surgeon with a clinic in Yelahanka, North Bangalore. Patients from Yelahanka, Jakkur, Hebbal, Thanisandra, Devanahalli, and the Airport corridor no longer travel to Central Bangalore for transplant consultations.
Patients from Sri Lanka, Bangladesh, Nepal, UAE, and Oman are coordinated with FRRO, medical visa letters, accommodation near hospital, and interpreter services when needed.
Send LFT reports, scans, and clinical summaries directly on WhatsApp for rapid assessment. Urgent cases are given same-week or next-day consultation slots.
MELD (Model for End-stage Liver Disease) is a numerical score from 6 to 40 calculated from three blood values: bilirubin (liver's ability to clear waste), creatinine (kidney function — often impaired in advanced cirrhosis), and INR (blood clotting ability). It predicts the risk of dying from liver disease within 90 days without transplant. MELD above 15 means transplant provides a survival benefit. MELD 25–30 means urgent evaluation and listing. MELD above 35 is a medical emergency. The score is recalculated periodically — it rises as disease progresses and drops if disease stabilises.
LDLT (Living Donor Liver Transplant) uses part of a living family member's liver. The main advantage is timing — surgery can happen within weeks, without waiting for a deceased organ. The liver regenerates fully in both donor and recipient. DDLT (Deceased Donor Liver Transplant) uses a whole liver from a brain-dead donor, allocated by the government organ authority (ZCCK in Karnataka). The advantage is no risk to a living donor. The limitation is waiting time, which depends on MELD score and organ availability. In India, LDLT is far more common than DDLT because deceased donation rates are very low compared to Western countries — India has about 0.8 deceased donors per million population vs 20–30 per million in Spain and USA.
A living liver donor must be: aged 18–55 years; blood group compatible with the recipient; in excellent health with no diabetes, hypertension, cardiac disease, or liver disease; not obese (BMI under 30); have no excess liver fat on MRI; have adequate liver volume remaining after donation (assessed by CT volumetry); have favourable hepatic artery and bile duct anatomy (assessed by MRI); and be genuinely voluntary — all potential donors are independently evaluated by the ethics committee to exclude coercion. Typically: spouse, parent, sibling, or adult child. 25–30% of potential donors are rejected after workup for medical, anatomical, or volumetric reasons.
Right lobe donation (adult-to-adult) carries a mortality risk of 0.1–0.5% at experienced centres. Major complication rates are 10–15%: the most common complication is bile leak (managed endoscopically in most cases), followed by post-operative liver insufficiency, wound infection, and hernia. Left lateral segment donation (for paediatric recipients) is lower risk. The donor's liver regenerates to near-normal size within 4–6 weeks. Long-term liver function tests, quality of life, and life expectancy are essentially normal in the vast majority of donors. Dr. Srinivas discusses all risks without minimisation during the donor evaluation process.
Liver transplant costs in Bangalore vary significantly by hospital type and complexity. Government hospitals: ₹10–20 lakhs. Private hospitals: ₹25–45 lakhs for LDLT; ₹20–40 lakhs for DDLT, depending on ICU duration and complications. These figures include surgery, ICU, hospital stay, immunosuppression for the first 3 months, and follow-up. Government insurance schemes (PMJAY/Ayushman Bharat) cover up to ₹5 lakhs towards liver transplant at empanelled hospitals. SAST Karnataka (State government scheme) covers transplant costs for eligible patients. Many private insurance plans now cover liver transplant — review your policy for organ transplant coverage. Contact Dhaara Liver Clinic for an individualised estimate.
Yes — the overwhelming majority of liver transplant recipients live a completely normal life. Most patients are mobile and eating by day 5–7. Hospital stay is 2–3 weeks total. Return to desk work: 6–8 weeks. Physical work: 3–4 months. Driving: from 6 weeks. Exercise: walking from day 5, swimming and gym from 3 months, sports from 6 months. Most patients are back to full activity within 6 months. Women can carry pregnancies after transplant — advised to wait 1–2 years post-transplant. The main day-to-day impact is taking 1–3 immunosuppression tablets daily and attending regular follow-up appointments — most patients find this easily manageable.
Hepatitis C: With pre-transplant or post-transplant DAA treatment (sofosbuvir/velpatasvir — 12 weeks), HCV is cured and the new liver is protected from re-infection. HCV recurrence is now rare with proper management. Hepatitis B: HBV will infect the new liver unless prevented. Standard protocol: lifelong low-dose HBV immunoglobulin + Tenofovir/Entecavir antiviral therapy. With modern protocols, HBV recurrence post-transplant is below 5% — compared to near 100% without prophylaxis. All HBV-related liver transplant recipients at Dr. Srinivas's programme receive evidence-based anti-HBV prophylaxis.
Yes — for HCC within defined criteria. Milan criteria (the standard): one tumour up to 5 cm, or up to 3 tumours each under 3 cm, with no vascular invasion and no extrahepatic disease. Within Milan, 5-year post-transplant survival is 70–75% — excellent results. Extended criteria (UCSF, University of Toronto) allow somewhat larger tumours in select cases. While waiting for transplant, patients with HCC receive bridging therapy — TACE (chemoembolisation), radiofrequency ablation, or SBRT — to prevent tumour progression. HCC is now one of the leading indications for liver transplant in India (20–25% of transplants), making transplant for liver cancer an increasingly important area of expertise.