When patients first come to us for consultation about a liver transplant for liver cirrhosis, I often see them overwhelmed — not only by the diagnosis but by the language we doctors use.
Terms like MELD, INR, bilirubin, decompensation, and graft sound complicated, even frightening.
But here’s the truth: understanding these terms doesn’t require a medical degree. Once you know what they mean, the transplant process feels far less intimidating.
So, in this article, we will decode the essential words and abbreviations you’ll hear during your transplant journey — explained in simple, patient-friendly language.
Understanding the Basics
Before diving into the glossary, let’s start with the foundation.
A liver transplant for liver cirrhosis becomes necessary when chronic damage (scarring) prevents the liver from performing its vital functions — detoxification, digestion, and metabolism.
During evaluation, doctors use various tests and scores to determine how badly the liver is failing and when a transplant is required. The following terms form the language of that evaluation.
Cirrhosis
Definition: Cirrhosis is the final stage of chronic liver disease where healthy liver tissue is replaced by scar tissue, disrupting normal function and blood flow.
Why it matters:
Cirrhosis is the most common reason patients are evaluated for transplant. It may be caused by:
- Chronic viral hepatitis (B or C)
- Long-term alcohol use
- Non-alcoholic fatty liver disease (NAFLD)
- Autoimmune hepatitis or genetic disorders
Key takeaway:
Cirrhosis itself can’t be reversed once advanced — but it can be cured through a liver transplant.
MELD Score (Model for End-Stage Liver Disease)
Definition: The MELD score is a numerical scale that predicts the severity of liver disease and helps prioritise patients for transplantation.
How it’s calculated:
It uses four blood test results —
- Bilirubin: how well the liver clears waste
- INR: how well the blood clots
- Creatinine: how well the kidneys are functioning
- Sodium (in the updated MELD-Na score)
Typical range:
- 6 (least severe) to 40 (most severe).
Why it matters:
A higher MELD score indicates a more urgent need for transplant.
In India, as in most countries, MELD scoring helps doctors decide the right time to list a patient for surgery — before complications become irreversible.
INR (International Normalised Ratio)
Definition: INR measures how long it takes your blood to clot.
Why it matters in liver disease:
The liver produces clotting factors. When it’s damaged, clotting slows down, and INR rises.
Normal INR: around 1.0
Abnormal in cirrhosis: >1.3 or higher
Key takeaway:
A high INR doesn’t just mean “thin blood” — it’s a marker of liver failure severity and is part of the MELD score formula.
Bilirubin
Definition: A yellow pigment formed when red blood cells break down. The liver normally removes it from the blood.
Why it matters:
When bilirubin builds up, you develop jaundice — yellowing of the eyes and skin.
High bilirubin levels also make patients fatigued and itchy.
Normal value: <1.2 mg/dL
In liver cirrhosis, often rises above 3–5 mg/dL or higher
Connection to transplant: Persistent high bilirubin is a clear indicator of liver failure progression.
Albumin
Definition: A protein made by the liver that helps maintain blood volume and carries hormones and vitamins.
Why it matters:
Low albumin causes swelling (oedema) and fluid buildup in the abdomen (ascites).
Normal range: 3.5–5.5 g/dL
Low in cirrhosis: below 3 g/dL
Improved albumin levels after transplant are often the first sign that the new liver is functioning beautifully.
AST, ALT (Liver Enzymes)
Definition: Enzymes that signal liver cell injury.
- AST (Aspartate Aminotransferase)
- ALT (Alanine Aminotransferase)
Normal range: 0–40 U/L
In liver disease, often 3–10 times higher
Key takeaway:
High AST/ALT mean the liver cells are inflamed or damaged. After a transplant, these numbers drop quickly as the new liver begins working.
Hepatic Encephalopathy
Definition: A condition where toxins (like ammonia) build up in the brain because the damaged liver can’t clear them.
Symptoms:
- Confusion
- Forgetfulness
- Tremors in hands
- Drowsiness
Why it matters:
It signals decompensation, meaning the liver can no longer perform its basic detoxification function — one of the clearest signs that a transplant should be considered soon.
Ascites
Definition: Fluid accumulation in the abdominal cavity due to increased pressure and protein loss.
Symptoms:
- Swollen, tense abdomen
- Breathlessness
- Weight gain due to retained fluid
Treatment:
Initially managed with diuretics and salt restriction, but if it becomes refractory (resistant), it’s another sign that only a liver transplant for liver cirrhosis can correct the root cause.
Portal Hypertension
Definition: Elevated pressure in the portal vein (which carries blood from the intestines to the liver) caused by scarring and obstruction.
Effects:
- Enlarged veins (varices) in the oesophagus or stomach
- Risk of internal bleeding
- Splenomegaly (enlarged spleen) and low platelets
Key takeaway:
When portal hypertension causes bleeding episodes or repeated ascites, medical management alone is no longer enough — it’s time to evaluate for transplant.
Child–Pugh Score
Definition: A scoring system (A–C) that grades liver function based on five factors — bilirubin, albumin, INR, ascites, and encephalopathy.
- Class A: Mild disease
- Class B: Moderate
- Class C: Severe, transplant indicated
Use:
It complements MELD in assessing severity, especially useful in patient discussions and pre-surgery counselling.
Decompensation
Definition: The tipping point where the liver stops compensating for damage and visible symptoms appear (jaundice, fluid, confusion, bleeding).
Why it matters:
It’s the moment when transplant discussions must begin. Once decompensation occurs, medicines can only manage symptoms, not restore liver health.
Graft
Definition: The transplanted liver or liver segment.
In living donor surgery, only a portion of the donor’s liver (left or right lobe) is used — this is called a partial graft.
Why it matters:
Both the donor’s and recipient’s livers regenerate over time, reaching near-normal size within 6–8 weeks — a fascinating example of nature’s healing power.
Immunosuppressants
Definition: Medicines that prevent your immune system from attacking the new liver (graft).
Examples: Tacrolimus, Cyclosporine, Mycophenolate, Prednisolone.
Why it matters:
These drugs are lifelong companions after transplant. They don’t weaken you — they protect your new liver. With proper dosage and monitoring, side effects are minimal.
Rejection
Definition: When the body’s immune system recognises the new liver as foreign and tries to attack it.
Signs:
- Rising liver enzymes
- Fever
- Jaundice recurrence
Good news:
Most rejections are mild and reversible if detected early. That’s why regular post-transplant tests are so important.
Biopsy
Definition: A small sample of liver tissue taken for microscopic examination.
Use:
- Before transplant: To confirm the extent of cirrhosis.
- After transplant: To check for rejection or other conditions.
Though the word “biopsy” worries many patients, it’s a simple, safe, and often painless procedure done under local anaesthesia.
Donor and Recipient Matching
Definition: The process of selecting a suitable donor based on blood group, size, and liver anatomy.
Types:
- Living donor (family member or close relative).
- Deceased donor (from organ donation networks).
Why it matters:
Compatibility ensures smooth surgery and faster recovery. In India, the living donor route is often chosen because waiting times for deceased organs can be long.
Ultrasound / FibroScan
Definition: Imaging tests that assess liver texture, blood flow, and stiffness.
Why it matters:
These are often the first investigations that reveal cirrhosis. FibroScan measures liver stiffness — a non-invasive alternative to biopsy in early stages.
End-Stage Liver Disease (ESLD)
Definition: The terminal stage of liver damage, where scarring and dysfunction are irreversible.
Key symptoms:
- Recurrent ascites
- Encephalopathy
- Variceal bleeding
- Weight loss and fatigue
At this point, the only curative treatment is a liver transplant for liver cirrhosis.
Post-Transplant Rehabilitation
Definition: The structured recovery phase after surgery, including medication management, physiotherapy, and diet counselling.
Why it matters:
A well-managed rehabilitation ensures faster recovery and long-term graft success. Patients usually return to normal activities within 3–6 months.
Putting It All Together
When you hear these terms during your transplant evaluation — MELD, INR, cirrhosis, portal hypertension, graft, immunosuppressants — remember they’re not barriers, but tools.
Each one represents a checkpoint that guides your doctors to make safe, informed decisions for your care.
The more you understand them, the more confident and empowered you become in your healing journey.
Key Takeaways
- Cirrhosis is irreversible, but a liver transplant for liver cirrhosis offers a complete cure.
- MELD and Child–Pugh scores decide timing and priority for transplant.
- INR, bilirubin, and albumin reflect the liver’s current performance.
- Post-transplant care, medicines, and monitoring ensure lifelong health.
- Knowledge reduces fear — understanding these terms is the first step toward confidence.
A Doctor’s Perspective
As a transplant surgeon, knowledge is as important as medicine. When patients understand the meaning behind their reports, they engage better, recover faster, and trust the process more deeply.So, whether you’re just beginning your journey or awaiting a transplant date, take time to familiarise yourself with these terms. You don’t have to memorise them — just understand them. Because in healthcare, awareness is healing.