Liver Transplant Specialist in Mumbai

What a liver transplant specialist does — and why it differs from the surgeon's role

The transplant surgeon removes the diseased liver and implants the donor organ. The transplant hepatologist’s scope is broader in time: evaluating whether a transplant is appropriate in the first place, calculating MELD scores to establish urgency, optimising the patient’s nutrition and haemodynamic status before surgery, coordinating pretransplant immunological workup, and managing immunosuppression and all its complications for years afterward.

These are two different disciplines. Most patients who first consult Dr. Kalal have a gastroenterologist or internist already, but their liver disease has crossed into territory where a transplant physician — not just a gastroenterologist — needs to lead the medical side. The scenarios include:

Cirrhosis with decompensation — ascites, variceal bleeding, or hepatic encephalopathy no longer controlled by medical management
Acute-on-chronic liver failure (ACLF) — rapid deterioration in a patient with known liver disease, where the bridge-to-transplant window can be very narrow
Acute liver failure (ALF) — where listing decisions must be made within hours and MELD alone does not tell the full story
Hepatocellular carcinoma (HCC) within or at the margin of Milan criteria — requiring tumour biology assessment alongside MELD
Metabolic liver disease, including MASLD/MASH with advanced fibrosis (F3–F4 on histology), where surgical risk must be weighed against disease trajectory
Cholestatic liver disease — primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), refractory to medical therapy

Credentials and transplant experience

Training: DM Hepatology & Transplant Medicine, Institute of Liver & Biliary Sciences (ILBS), New Delhi, 2013–2016. ILBS runs one of South Asia’s highest-volume liver transplant programmes. Mentor: Professor Shiv Kumar Sarin, founding chair of the APASL ACLF Research Consortium (AARC) — the largest international cohort defining ACLF management and transplant thresholds in Asia.

Experience: Over 1,500 transplant procedures across Dr. Kalal’s career — living-donor (LDLT), deceased-donor (DDLT), ABO-incompatible, and paediatric cases — spanning training at ILBS and clinical practice at Global Hospital, Sir HN Reliance Foundation Hospital, and Gleneagles Hospital Mumbai.

Current position: Associate Director, Hepatology & Liver Transplant, Gleneagles Hospital, 35 Dr Ernest Borges Road, Parel, Mumbai 400012.

Research: 26 PubMed-indexed publications. Active investigator, APASL AARC — the consortium whose grading criteria (AARC-ACLF score) are the current standard across Asia for determining transplant urgency in ACLF. AASLD Young Investigator Award 2016 and 2017. EASL Young Investigator Full Bursary 2016 and 2017. Co-author, Kyoto Consensus on ACLF 2025 (Hepatology International, PMID 39961976).

The Malatya approach — a published technical innovation in liver transplantation

In right-lobe living-donor liver transplantation, the anatomy of the portal vein is critical. A proportion of donors have anomalous portal venous branching — a variant in which the standard surgical approach to portal reconstruction carries a higher risk of graft complications or may require significant modification of the donor graft.

The Malatya approach addresses this specifically. Published in Liver Transplantation, the flagship journal of the field, in 2017 (Kalal CR, Hatimi H, Mohanka R. Vol. 23(11):1482–1483. DOI 10.1002/lt.24852. PMID 28834220), this technical communication describes the reconstruction of anomalous portal venous branching in a way that preserves optimal flow geometry to the graft.

What this means for patients: complex anatomy cases that might previously have required abandonment of the planned procedure or a technically compromised reconstruction can be managed safely. First-authored by Dr. Kalal in collaboration with the surgical team, this publication reflects a level of involvement in transplant operative decision-making that goes well beyond typical hepatology practice.

When is a liver transplant indicated?

The MELD score (Model for End-Stage Liver Disease) is the primary tool used in India and internationally. MELD 3.0 — the updated formula that incorporates sex as a variable — is now preferred in most centres. A MELD above 15 generally begins the formal listing discussion; above 20, the urgency increases significantly; above 25, the mortality risk from waiting typically outweighs the risk of transplant surgery.

MELD is a tool, not a verdict. The clinical pattern matters as much as the number. Specific situations where Dr. Kalal initiates a transplant evaluation:

Cirrhosis-related decompensation

Recurrent or refractory ascites requiring large-volume paracentesis more than twice monthly
One or more episodes of variceal bleeding uncontrolled or recurring despite band ligation
First episode of spontaneous bacterial peritonitis (SBP) — a recognised listing trigger
Hepatic encephalopathy affecting quality of life despite lactulose and rifaximin
Hepatorenal syndrome (HRS) — MELD is typically very high at this stage

Acute-on-chronic liver failure (ACLF)

ACLF grade 2–3, as defined by the APASL AARC criteria, carries a 28-day mortality of 50–70% without transplant. For patients who have a potentially reversible precipitant (bacterial infection, alcohol binge, viral hepatitis flare), a careful bridge-to-transplant strategy — nutritional rehabilitation, infection clearance, careful organ support — may create a window for listing and donor evaluation. This is one of the most time-critical situations in hepatology.

Hepatocellular carcinoma (HCC)

HCC within Milan criteria (single tumour ≤5 cm, or up to 3 tumours each ≤3 cm, no macrovascular invasion, no extrahepatic spread) is a standard transplant indication globally. Patients at the margin of Milan criteria require careful tumour biology assessment and are discussed case by case at the MDT.

Acute liver failure (ALF)

The decision window in ALF can be measured in hours. King’s College Criteria and MELD guide the threshold, but the rate of encephalopathy progression and the INR trajectory often signal listing urgency before any single score reaches the conventional cutoff.

The liver transplant pathway at Gleneagles Hospital, Mumbai

Dr. Kalal’s role is medical leadership through each of these stages:

Evaluation — full metabolic panel, MELD 3.0 calculation, Child-Pugh classification, triphasic CT liver (or contrast MRI), echocardiography, pulmonary function, nutritional assessment including sarcopenia screening (grip strength, CT cross-sectional muscle area at L3)
MDT review — hepatologist, transplant surgeon, cardiac anaesthesiologist, dietitian, and psychiatrist review each candidate jointly. No patient is listed by one clinician alone.
Listing — cadaveric organ allocation in Maharashtra goes through ZTCC Mumbai (Zonal Transplant Coordination Centre) under NOTTO (National Organ & Tissue Transplant Organisation). MELD score determines queue position; blood group determines eligibility pool.
Living donor evaluation (LDLT) — where a related donor offers, volumetric CT (measuring right-lobe graft-to-recipient weight ratio) and a separate MDT review of the donor are conducted. Dr. Kalal coordinates the hepatology aspects; the surgical team leads donor hepatectomy workup.
Bridge management — for patients on the waitlist, active medical management continues: nutritional optimisation (targeting protein 1.2–1.5 g/kg/day), infection surveillance and prophylaxis, monitoring for ACLF precipitants, and repeat MELD calculation at fixed intervals.
Post-transplant immunosuppression — tacrolimus-based protocols, calibrated against renal function, drug interactions (notably antifungals and macrolides), and rejection risk stratification. Long-term management of post-transplant metabolic syndrome — diabetes, dyslipidaemia, hypertension, and de novo MASLD — is Dr. Kalal’s domain.
Long-term follow-up — most patients are seen monthly for the first year, quarterly for the next two years, then 6-monthly as the clinical situation stabilises. Rejection surveillance via protocol biopsies is discussed with each patient based on their immunological risk.

For patients coming from outside Mumbai

Dr. Kalal offers virtual pre-transplant consultations for patients travelling from other cities or from abroad. A structured telemedicine second opinion is particularly useful before you commit to travelling, and allows the team to identify any pretransplant workup that can be completed at your local centre.

To enable a meaningful remote assessment, bring the following when you book:

LFTs, renal function (creatinine, sodium), INR — within the past four weeks
Triphasic CT liver or gadolinium contrast MRI — within three months
Upper GI endoscopy report (grading of oesophageal varices, if any)
Echocardiogram (left ventricular ejection fraction; evidence of pulmonary hypertension)
Liver biopsy report if available
Current medication list and any previous treatment summary

Book via the Gleneagles Hospital appointment line or through the online consultation form on this site.

Frequently Asked Questions

What is the difference between a liver transplant surgeon and a liver transplant specialist (hepatologist)?

The surgeon performs the operation — removing the diseased liver, implanting the donor organ, and reconstructing the biliary and vascular anatomy. The hepatologist (transplant specialist) determines candidacy, calculates MELD scores, manages the patient medically before and after surgery, prescribes and titrates immunosuppression, and handles complications including rejection, opportunistic infection, and post-transplant metabolic syndrome. Both are essential; in established programmes, they work as a joint medical–surgical team. Dr. Kalal leads the medical side.

How do I know if I need a liver transplant?

Your treating hepatologist will calculate your MELD score and assess your pattern of decompensation. The key triggers are: refractory ascites, hepatic encephalopathy, a MELD score above 15, HCC within transplant criteria, or ACLF grade 2–3. If you have been told you have “end-stage liver disease” but have not yet been formally evaluated by a transplant hepatologist, that consultation is the next step. A second opinion is always appropriate at this stage — the decision to list is irreversible and should be made carefully.

What is the typical waiting time for a liver transplant in Mumbai?

Deceased-donor liver transplant (DDLT) wait times in Maharashtra depend on ZTCC allocation, blood group, and MELD score — the highest MELD scores are allocated first. Living-donor liver transplant (LDLT), where a healthy related donor donates the right lobe of their liver, eliminates the waiting list entirely and accounts for approximately 80–90% of transplants performed in India. If a suitable donor is identified, the timeline is determined by workup and surgical scheduling, typically six to ten weeks.

What is the Malatya approach?

The Malatya approach is a method for reconstructing anomalous portal venous branching in right-lobe living-donor liver transplantation. Published in Liver Transplantation in 2017 (Kalal CR, Hatimi H, Mohanka R; PMID 28834220), it describes how to safely manage an anatomical variant in the donor’s portal vein — one that can complicate or compromise standard right-lobe LDLT. This technique was developed and published by Dr. Kalal in collaboration with the transplant surgical team during his work at Global Hospital, Mumbai.

Can I consult Dr. Kalal if I am coming from another state or from abroad?

Yes. Virtual pre-transplant consultations are available for patients from outside Mumbai — whether from another Indian city or from overseas. Bring the documents listed above. If after the virtual assessment you are confirmed as a transplant candidate, the team will plan your in-person workup and MDT scheduling. Many NRI patients complete their initial transplant evaluation remotely and travel to Mumbai only for the in-person MDT review and surgical planning.

What is life like after a liver transplant?

The post-transplant period involves lifelong follow-up. Immunosuppression — typically tacrolimus, sometimes with mycophenolate or low-dose steroids — must be taken daily; doses are titrated against trough levels and renal function. Acute rejection is most common in the first six months and is treated with pulse methylprednisolone in most cases. Long-term risks include hypertension, diabetes, dyslipidaemia, and renal impairment, all driven or worsened by immunosuppressants. Five-year graft survival for LDLT in experienced Indian centres is approximately 80–85%. Regular follow-up with a transplant hepatologist is lifelong — this is not a “cured and discharged” situation.