Liver Cirrhosis Specialist — Mumbai
Liver Cirrhosis: Diagnosis, Management & Transplant
Dr. Chetan Kalal — DM Hepatologist, Gleneagles Hospital Mumbai. 1,000+ cirrhosis patients managed annually. ACLF specialist, 26 PubMed publications.
What Is Liver Cirrhosis?
Cirrhosis is the final common pathway of chronic liver injury — normal liver tissue replaced by scar (fibrosis), distorting architecture and impairing function. It is not a single disease but the endpoint of hepatitis B, hepatitis C, alcohol-related liver disease, MASLD (fatty liver), autoimmune hepatitis, Wilson’s disease, and other chronic conditions.
Once cirrhosis is established, the priority shifts from treating the underlying cause alone to preventing and managing its complications: variceal bleeding, ascites, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, hepatorenal syndrome, and hepatocellular carcinoma (HCC). This is the core of hepatologist-led care.
Complications Dr. Kalal Manages
Variceal Bleeding
Endoscopic band ligation (EBL), TIPS evaluation, secondary prophylaxis with carvedilol or NSBB. Upper GI endoscopy for screening and treatment.
Ascites & SBP
Diuretic titration, large-volume paracentesis, albumin infusion, TIPS evaluation. SBP diagnosis and treatment with IV cefotaxime and albumin.
Hepatic Encephalopathy
Identification of precipitants, lactulose titration, rifaximin, ammonia management. Covert HE screening with validated tools. TIPS-related HE management.
Hepatorenal Syndrome
Type 1 and Type 2 HRS — terlipressin + albumin protocol per EASL 2023 guidelines. Renal replacement therapy decision. Transplant evaluation for HRS-AKI.
Infections in Cirrhosis
SBP, UTI, pneumonia — empirical antibiotics per resistance patterns. ACLF precipitated by infection: early identification and escalation. Antibiotic prophylaxis in high-risk patients.
Liver Cancer Surveillance
6-monthly ultrasound + AFP per APASL/EASL guidelines. CECT/MRI for LI-RADS characterisation. MDT decision for ablation, TACE, SIRT, or transplant (Milan/UCSF criteria).
Nutrition & Sarcopenia
Cirrhosis-specific nutrition assessment: MAMC, handgrip strength, CT L3 muscle index. Late-evening snack, BCAA supplementation, protein targets. Research focus area for Dr. Kalal.
Liver Transplant Evaluation
MELD-Na scoring, listing criteria, LDLT vs DDLT decision, donor evaluation. Post-transplant follow-up, immunosuppression management, rejection and infection monitoring.
Causes of Cirrhosis — What Needs to Be Treated
Most common cause in India. Abstinence is the only disease-modifying intervention. Nutritional rehabilitation is critical — most patients are severely malnourished.
Antiviral therapy (tenofovir or entecavir) suppresses viral replication, halts fibrosis progression, and reduces HCC risk even in established cirrhosis. Lifelong treatment in most.
Direct-acting antivirals (DAAs) achieve SVR >95% and can reverse fibrosis in early cirrhosis. HCC surveillance must continue even after cure.
The fastest-growing cause globally. Weight loss, metabolic control, and emerging therapies (GLP-1 agonists, resmetirom). Dr. Kalal has particular expertise — advisory panels with Novo Nordisk and Eli Lilly.
Immunosuppression (prednisolone + azathioprine). Treatment-refractory disease may require liver transplant. Regular monitoring of autoantibodies and IgG levels.
Metabolic liver diseases with genetic basis. D-penicillamine/trientine for Wilson’s; phlebotomy for haemochromatosis. Genetic counselling for family members.
Understanding ACLF — When Cirrhosis Becomes Critical
Acute-on-chronic liver failure (ACLF) is a distinct syndrome — acute deterioration on the background of cirrhosis, with organ failures and 28-day mortality of 30–50%. Precipitants include bacterial infection, alcohol, viral reactivation, and GI bleeding.
Dr. Kalal is a member of the APASL AARC (Asian Pacific Association for the Study of the Liver — ACLF Research Consortium) working group and PI of the MAHAL RCT — India’s largest ACLF trial. For patients admitted with ACLF, early aggressive care with ACLF-grade-specific management changes outcomes.
When Should You See a Hepatologist for Cirrhosis?
If you have been told you have liver fibrosis, cirrhosis, or a MELD score — or if you have had ascites, a bleed from varices, or confusion — a hepatologist-led review changes the management plan. Don’t wait for the next admission.
Liver Cirrhosis Specialist — Serving Patients Across Mumbai
ThaneNavi MumbaiPuneNashik
AhmedabadSuratHyderabadBangalore
Dr. Chetan Kalal consults at Gleneagles Hospital, Parel, Mumbai. Tele-consultations available for outstation patients.