When to time transplant
All patients who have moderate synthetic dysfunction due to liver cirrhosis should be evaluated and listed for cadaveric liver transplant early. The average international waiting time for cadaveric liver is about 8 to 12 months. This is likely to be even longer in India. Hence there is a lot of sense in early enrollment. Close follow up by the transplant team is essential during the waiting period to attend to the intercurrent medical problems that may contraindicate transplant. The following are the indications for evaluation and early listing for transplant- Prothrombin time raised 5 seconds above control value, Serum Albumin < 3.5 G/dl, Ascites(fluid in the belly) not responsive to medications, one episode of infection in ascites(SBP), episodes of gastrointestinal bleeding and presence of gastric-fundal varices (on endoscopy). The advantages of early transplant include cost saving on recurrent therapy for medical illness which is common in chronic liver disease and better post transplant outcome.