End Stage Liver Failure (Decompensated Chronic Liver Disease/Liver Cirrhosis): End stage liver Failure is the most common reason when a liver transplant is the only treatment option for complete cure. End stage liver failure or Decompensated Chronic Liver Disease is the end result of a host of liver diseases causing Liver Cirrhosis and increased pressure in liver blood vessels (Portal hypertension) leading to secondary problems like accumulation of fluid in abdomen (Ascites) and frequent infection (Spontaneous bacterial peritonitis or SBP), bleeding in the digestive tract manifesting as massive blood vomiting or passing of black colored stools, episodes of altered mentation or coma (Hepatic encephalopathy) and or decrease in urine output and deterioration in kidney function. Acute on Chronic Liver Failure: Unlike patients of liver cirrhosis and portal hypertension in whom liver failure takes years to develop, there are subset of patients in whom liver failure can happen within a span of weeks to months. This phenomenon is usually seen in alcoholics who are heavy drinkers or in patients of hepatitis B where there is sudden and rapid flare up or reactivation of the disease. The rapid development of liver failure is mostly secondary to any acute insult to the body like bouts of heavy drinking or any infection leading to decreased in body immunity etc. These type of patients become very sick very soon and carries a very high risk of mortality without a transplant. In such cases an urgent liver transplant is needed to save the life of the patient without which the chances of survival remains dismal.

Acute on Chronic Liver Failure: Unlike patients of liver cirrhosis and portal hypertension in whom liver failure takes years to develop, there are subset of patients in whom liver failure can happen within a span of weeks to months. This phenomenon is usually seen in alcoholics who are heavy drinkers or in patients of hepatitis B where there is sudden and rapid flare up or reactivation of the disease. The rapid development of liver failure is mostly secondary to any acute insult to the body like bouts of heavy drinking or any infection leading to decreased in body immunity etc. These type of patients become very sick very soon and carries a very high risk of mortality without a transplant. In such cases an urgent liver transplant is needed to save the life of the patient without which the chances of survival remains dismal.

Acute Liver failure: It is another unique variety of liver failure which develop in otherwise healthy individual (even children) with no history or evidence of any liver disease. It usually develops in a span of days and week (3-4 weeks) and survival without transplant is very dismal. The common causes of such liver failure includes infection with hepatitis virus (A, E or B), drug toxicity ( paracetamol, halothane, anti TB drugs etc), consumption of toxins (rat poison, herbal preparations with heavy metals), certain congenital diseases (Wilson’s Disease, Autoimmune hepatitis) or during pregnancy. These patients require an emergency liver transplant within a span of few hours (24-48 hours) otherwise they may not survive.

Liver Cancers: The most common liver cancer is an hepatocellular carcinoma. It usually develops secondary to long standing liver cirrhosis due to hepatitis B or C. However it can develop in liver cirrhosis of any cause. If timely treatment is started for hepatitis B or C, then the development of liver cancers be prevented. But once cancer develops in a patients of liver cirrhosis liver transplant remains the possible best form of cure provided the tumor is small (less than 8 cm in size) and limited to liver and there is no involvement of liver blood vessels. Resection surgery (removal of cancer alone without transplant can be done in selected group of patients). Liver cancers which are  very large, advanced or involve blood vessels are usually not curable with  liver transplant and chances of recurrences are very high. Such type of cancers are offered other palliative treatment options like TACE, TARE or SBRT or radiotherapy or immunotherapy.

Apart from this some other rare form of liver cancers can exist like cholangiocarcinoma, hepatoblastoma (in children), hemangioendothelial cancers or a mixed cholangiohepatocellular cancers.

Cholestatic Disorders: Apart from these regular diseases certain other autoimmune disease like primary sclerosing cholangitis(PBS) or primary biliary cirrhosis (PBC) can effect the leading and can cause progressive damage to an extent of liver failure and need for liver transplant.

Congenital or metabolic Disorders: A host of liver diseases can occur congenitally and effect children and can cause extensive liver damage in the very young age. Diseases like Biliary atresia or Progressive Familial intrahepatic cholestasis (PFIC) are most common cause of liver failure in children. Apart from these certain metabolic disorders like tyrosinemia, maple syrup urinary disease, glycogen storage disease, hyperoxaluria etc can cause serious issues in normal development of young children and can only be cured by a liver transplant.

Vascular Disorders affecting Liver: A host of congenital or aquired diseases can causes blockage of blood vessels of liver especially the hepatic veins (Budd Chairi Syndrome) leading to liver failure of varying degrees. Liver transplant can be life- saving operation in such cases provided the other lesser treatment modalities fail or are unsuccessful.

Other disorders: Liver transplant may also be required in some miscellaneous situations like extensive traumatic liver damage, secondary biliary cirrhosis or chronic rejection or graft loss following a liver transplant.