MELD and Child-Pugh Scores: Grading Cirrhosis and Timing a Transplant

The first step is to determine whether cirrhosis has actually developed, using a fibroscan or, less often now, a liver biopsy. If the disease is only at the steatohepatitis stage (fatty liver inflammation with no fibrosis yet), controlling risk factors can make it fully resolve. If cirrhosis has already developed, the patient is kept under regular monitoring, since there is no way to predict when a cirrhotic liver will start to fail.

On examination, jaundice, ascites, leg oedema, spider angiomas, palmar erythema and gynaecomastia are the telltale signs of cirrhosis. Unfortunately, these are only seen in advanced cirrhosis. Since the goal is to catch cirrhosis before complications develop, an ultrasound or fibroscan done proactively is the better approach for early diagnosis.

For hepatitis B, tenofovir and entecavir are very effective drugs with low resistance levels that can practically control the virus. For hepatitis C, directly-acting agents such as sofosbuvir and velpatasvir are very effective and can practically eliminate the virus from the body.

The donor is admitted for about seven days. By the third or fourth day, the donor is walking around, eating, and relatively pain-free, and is discharged by day six or seven. A follow-up OPD visit happens on day 10; if doing fine, the donor can return to their home country and resume office and light household work, with the only restriction being on lifting heavy weights.

This depends on how sick the recipient was before surgery: a weaker, sicker patient takes longer to recover. The recipient typically stays in hospital for around 18 days, with discharges starting around day 12-13 and about 95% discharged by day 18. Complete recovery, meaning a return to normal muscle mass and full function, takes about two to three months. After 2-3 weeks of local follow-up near the hospital in India, the patient can return to their home country and continue follow-up from there.

Both grade the severity of cirrhosis using lab values (and, for Child-Pugh, clinical parameters) and are used to recommend the timing of a liver transplant.

A distinct, more urgent condition from cirrhosis where the liver fails suddenly, often from drug poisoning or hepatitis A/E, with death possible within 10-15 days without transplant.