Centre for Liver Transplant Surgery, Bangalore

The liver is a resilient organ — it can compensate for significant damage for years before giving way. But when compensation fails and the liver can no longer perform its core functions — filtering toxins, producing clotting factors, metabolising drugs, synthesising proteins, and maintaining fluid balance — liver transplantation becomes the only intervention that can restore normal physiology and save the patient's life.

As a liver transplant surgeon in Bangalore, Dr. Srinivas Bojanapu evaluates every patient for transplant candidacy based on the severity of liver dysfunction (quantified by MELD score), the underlying cause of disease, the presence of complications such as hepatic encephalopathy, refractory ascites or hepatorenal syndrome, and the patient's overall physiological reserve. Transplantation is not recommended lightly — the decision is made only when the benefits of surgery clearly outweigh the risks of a major operation and lifelong immunosuppression.

• Decompensated Cirrhosis When cirrhosis progresses beyond compensation to jaundice, ascites, variceal bleeding, or hepatic encephalopathy that cannot be controlled with medical or endoscopic therapy.
• Acute Liver Failure Sudden, life-threatening liver collapse from viral hepatitis, drug toxicity (paracetamol overdose, herbal supplements), or Wilson's disease, requiring emergency listing through the ZCCK or TRANSTAN deceased donor registry.
• HCC within Milan Criteria A single tumour ≤5 cm, or up to three tumours each ≤3 cm, confined to the liver with no vascular invasion. Transplant offers both oncological cure and removal of the cirrhotic background liver that would generate future tumours.
• Alcohol-Related Liver Disease Selected patients with severe alcoholic hepatitis unresponsive to steroids, or end-stage alcoholic cirrhosis, following rigorous psychosocial evaluation and documented sobriety commitment.
• Metabolic Liver Diseases Wilson's disease, end-stage haemochromatosis, MASLD-related F4 cirrhosis with complications, and primary biliary cholangitis or primary sclerosing cholangitis failing all medical therapies.
• Chronic Hepatitis B & C Cirrhosis Despite highly effective antivirals (TAF for HBV, DAAs for HCV), patients who present late with established decompensated cirrhosis will not recover adequate synthetic function on medications alone and require transplant evaluation.

Our transplant programme in Bangalore offers both pathways simultaneously. This is clinically important: many patients are evaluated for LDLT and DDLT in parallel, so that if the preferred living donor is found to be unsuitable at the last stage of workup, the deceased donor listing is already active. LDLT provides speed, organ quality, and surgical control; DDLT provides access for patients without a compatible living donor.

Choosing between a living donor and a deceased donor transplant is one of the most consequential decisions a patient and family will make. The comparison below covers every factor that influences the choice — from organ quality and surgical timing to cost structure and donor risk. This table is reviewed in detail at every transplant consultation at our Bangalore centre.

Scroll right to view full table on mobile.

Before any patient is listed for transplant — whether LDLT or DDLT — they undergo a comprehensive multi-disciplinary workup that typically takes place over five days at our Bangalore centre. This evaluation serves two purposes: to confirm that transplant is the correct treatment, and to identify and optimise any conditions that could increase peri-operative risk. The same evaluation applies independently to the proposed living donor, conducted by a separate surgical team to ensure no conflict of interest influences the assessment.

Liver transplant recipients are placed on high-dose immunosuppression in the early post-operative period, making them profoundly susceptible to bacterial, fungal, and viral infections during the critical first 90 days. Our transplant programme in Bangalore employs a multi-layered infection prevention strategy, maintained continuously by the nursing, pharmacy, and intensivist teams around the clock.

A successful liver transplant is not the end of treatment — it is the beginning of a new chapter that requires lifelong engagement with the transplant team. The first year is the most demanding: drug doses change weekly, the immune system is being recalibrated, and the graft is still being accepted. Beyond 12 months, the vast majority of patients lead near-normal lives, return to work, travel, and require only quarterly or biannual reviews. Understanding the trajectory allows patients and families to plan realistically.

• Hospital Discharge Timeline Recipients typically spend 5–7 days in the transplant ICU, followed by 10–15 days in the hepatology ward. Total hospitalisation for uncomplicated LDLT is 15–22 days. Donors are discharged in 5–7 days.
• Immunosuppression for Life Tacrolimus (FK506) remains the backbone of long-term immunosuppression, typically combined with mycophenolate mofetil in the first year. Doses are reduced progressively as tolerance develops but cannot be discontinued.
• Follow-Up Schedule Weekly for the first month, fortnightly for months 2–3, monthly through the first year, then quarterly indefinitely. Blood tests at every visit monitor graft function, drug levels, and renal function.
• Dietary Restrictions High-protein, low-sodium diet for the first 6 months. Raw or undercooked foods are prohibited while on high-dose immunosuppression. Grapefruit and pomelo are permanently contraindicated due to CYP3A4 inhibition which dangerously elevates tacrolimus levels.
• Permanent Prohibitions Alcohol — zero tolerance, lifelong. Herbal and Ayurvedic supplements — many are hepatotoxic and can precipitate acute graft rejection by competing with immunosuppressant metabolism. NSAIDs — nephrotoxic in combination with tacrolimus and calcineurin inhibitors.
• Return to Normal Activity Light walking from week 2 post-discharge. Driving from week 6–8. Desk work and light activity from month 2. Physical labour, contact sports, or heavy lifting only after 6 months and with explicit surgical clearance.

Liver transplantation is the most team-dependent operation in surgery. The outcome is determined not just by the surgical technique of the liver transplant surgeon but by the integrated performance of every specialist who touches the patient from the moment of listing to the decade of follow-up that follows. Our transplant team in Bangalore is constituted to cover every dimension of this journey.