Decompensated Liver Disease: Liver Transplantation is the Best Option, Not the Last Option

The incidence of end stage liver disease and liver transplantation is on the rise in Kerala. All practicing doctors should have an insight into the indications, contraindications, evaluation leading to and complications following liver transplantation. Liver transplantation is now an accepted modality of treatment in end stage liver disease and hepatocellular carcinoma. With potent immunosuppression and newer surgical techniques the 5 year survival rate following liver transplantation is above 75%. It is higher than that for surgeries for most gastro-intestinal cancers. The process to reach liver transplantation starts with early referral to the transplant centre, where extensive investigations performed. Once the patient is accepted into the waiting list, then prioritization for the transplant relies on the MELD score as well as matching the blood group and patient size. Immunosuppression after transplant requires a balance between prevention of graft rejection and minimization of the side effects of immunosuppressive drugs. Lifelong after-care is crucial for long-term graft and patient survival after liver transplantation. Keywords: End stage liver disease, Early referral, MELD score, Better immunosuppression, Cirrhosis Liver, Liver Transplantation, Hepatocellular Carcinoma, Acute liver failure, Metabolic liver diseases