Pace Hospitals | Best Hospitals in Hyderabad, Telangana, India
LIVER FAILURE TREATMENT

Liver Failure Treatment in Hyderabad, India

PACE Hospitals is renowned as one of the best hospital for Liver Failure Treatment in Hyderabad, India, offering a comprehensive and multidisciplinary approach to managing both acute and chronic liver failure. The hospital is equipped with cutting-edge diagnostic and therapeutic technology, innovative treatments, enabling precise evaluation and treatment of liver failure. A team of highly skilled liver specialists - hepatologists, gastroenterologists, liver transplant surgeons, and critical care specialists collaborate to deliver personalized care for each patient.


PACE Hospitals offers a full spectrum of treatments, ranging from medical management of liver failure to advanced liver transplants, supported by world-class liver ICU facilities and post-operative care units. With its focus on patient-centered care, rapid recovery protocols, and compassionate support for patients and families, PACE Hospitals has earned a reputation as one of the best liver failure treatment hospital in India.

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what are the diagnosis of liver failure

Diagnosis of liver failure

The hepatologist, after seeking the patient’s entire medical history, diagnoses acute liver failure based on:

  • Physical examination
  • Laboratory tests
  • Abdominal imaging


During the process of history taking, the hepatologist may ask the patient regarding:

  • Previous episodes of jaundice
  • Past medication history if any
  • Alcohol consumption
  • family history of liver disease
  • risk factors for viral hepatitis
  • exposure to any hepatic toxins

Physical examination of liver failure

During the physical examination, the hepatologist evaluate objective anatomical findings (findings from a medical evaluation that are not under patient’s control) by:

  • Observation
  • Palpation (Feeling the organs or tissues beneath the skin by applying pressure to the body's surface)
  • Percussion (technique for physically examining a body part by tapping it with the palms, fingers, or tiny tools)
  • Auscultation (listening to sounds coming from the lungs, heart, or other organs, usually with a stethoscope)


The hepatologist may examine the following:

Eyes: for the signs of jaundice (yellowish discolouration of eyes) and papilledema (optic disc swelling in the eye)

Abdomen: for the presence of ascites (fluid accumulation in the abdomen) and abdominal swelling

Upper and lower limbs: for the presence of oedema (fluid build-up)

Laboratory tests for liver failure

Liver function tests

The liver plays a crucial role in metabolism, digestion, detoxification, and substance elimination. Liver Function Tests like alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphate (ALP), gamma glutamyl transferase (GGT) serum bilirubin, prothrombin time (PT), the international normalized ratio (INR), total protein and albumin. can identify liver damage areas and aid differential diagnosis. Elevations in liver enzymes and other substances released by liver indicates hepatocellular disease.


Other laboratory tests that may be advised to diagnose liver failure include:

  • Serum creatinine
  • Complete blood picture
  • Serum electrolytes

People with liver failure may also have elevated levels of creatinine, abnormal electrolytes, and signs of anaemia.


Serology and polymerised chain reaction (PCR) techniques

In order to identify the cause of liver failure serological tests and PCR techniques are used to evaluate Viral hepatitis, autoimmune antibodies (anti-nuclear antibodies [ANA], anti-smooth muscle antibodies (ASMA), anti-liver-kidney microsomal antibodies type 1 (ALKM-1) and serum IgG immunoglobulins for autoimmune hepatitis, and anti-mitochondrial antibodies for primary biliary cholangitis. Additional helpful tests include serum alpha-fetoprotein for hepatocellular carcinoma (HCC), ceruloplasmin and urine copper for Wilson disease, alpha 1-antitrypsin level and protease inhibitor phenotype for alpha 1-antitrypsin deficiency, and ferritin and transferrin saturation for hemochromatosis.

Imaging tests and liver biopsy

In addition to laboratory tests, a variety of imaging modalities which may include ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and transient elastography (fibro scan) are utilized to aid in the diagnosis of liver failure.

  • Ultrasonography: For the assessment of liver failure, ultrasonography is an affordable, non-invasive, and accessible method. It can identify nodules and elevated liver echogenicity.
    Computed tomography (CT) and magnetic resonance imaging (MRI): To rule out other potential reasons of the loss in mental state, head imaging with these scans is performed. These include cerebral mass lesions, particularly hematomas, which might mimic oedema from fulminant hepatic failure. Though MRIs and CT scans can both detect liver failure in an indirect manner, they cannot identify the disease directly. Other diagnostic procedures along with specialised evaluations, clinical signs, are usually used to diagnose liver failure.
  • Transient elastography (fibro scan): Transient elastography, also known as fibro scan, is a non-invasive technique that measures liver stiffness that is correlated with fibrosis, using high-velocity ultrasound pulses.
  • Liver biopsy: Small tissue samples of the liver are examined under a microscope to detect liver problems, mainly to confirm the presence of abnormal or cancerous cells in the liver. A liver biopsy can reveal real information about the current functioning status of the liver.


        In general, liver biopsy can be taken through three ways, namely:

  • Percutaneous liver biopsy
  • Laparoscopic liver biopsy
  • Transvenous liver biopsy

Stages of liver failure

Stages of acute liver failure

Acute liver failure is divided in to three categories. A hepatologist named O'Grady and his associates created the King's categorization in 1993; it is widely utilized in the United Kingdom. This classification allows for the subclassification of acute liver failure as

  • hyperacute liver failure, which occurs within 7 days of the onset of jaundice,
  • acute liver failure, which occurs between 1 and 4 weeks, and 
  • subacute liver failure, which occurs between 5 and 12 weeks.


Stages of acute on chronic liver failure

Several studies have confirmed the utility of grading acute on chronic liver failure in aiding clinicians to determine prognosis. Three grades are used to categorize acute on chronic liver failure according to its severity:

  • Grade 1 acute on chronic liver failure is considered if there is presence of 
  • Single kidney failure
  • Any combination of hepatic encephalopathy (brain illness due to impaired liver function) grade 1 or grade 2, single liver, coagulation, circulatory, or lung failure with a serum creatinine level between 1.5 and 1.9 mg/dL
  • brain failure with 1.5–1.9 mg/dl of serum creatinine.


  • Grade 2 acute on chronic liver failure is considered when there is a combination of two organs failure. 
  • Grade 3 acute on chronic liver failure is considered when there is multiple organ failure.

Differential diagnosis of liver failure

The other medical conditions that share the similar clinical features with liver failure include:

  • Non-steroidal anti-inflammatory drugs poisoning 
  • Mushroom poisoning
  • Acute fatty liver of pregnancy (AFLP)
  • Cholestasis (impaired bile outflow)
  • Ebola virus
  • Galactosemia (genetic disorder that impairs galactose sugar breakdown)
  • Haemolysis, elevated liver enzymes, low platelet count (HELLP syndrome)
  • Hypersensitivity
  • Lassa virus
  • Marburg virus
  • Neonatal iron storage disease
  • Severe acute hepatitis
  • Tyrosinemia (genetic disorder that impairs tyrosine amino acid breakdown)
  • Drug reaction due to an unknown cause

Considerations of a hepatologist before opting for a liver transplant

To guarantee appropriate results for the patient, surgeons must consider several things before deciding to perform a liver transplant. The considerations may include:

  • Assessment of end stage liver disease: For successful management of liver failure, the hepatologist may consider the hemodynamic profile of the patient since the hepatic failure is caused by excessive production of vasodilators (substances that cause dilation of blood vessels).
  • Anaesthesia management and surgical interventions: Making sure that the transplant group has the most up-to-date information and expertise about anaesthesia and surgery.
  • Immunosuppressants selection: Selecting the most effective immunosuppressive technique to avoid transplant rejection and reduce unwanted effects.
  • Comorbid conditions: Assessing the patient's general health as well as any comorbid conditions that might interfere with surgery or the healing process.
  • Preoperative Optimization: Hematologists thoroughly discuss the risks, advantages, and non-surgical options with patients prior to liver transplantation. Another crucial component of patient care that the surgeon must consider is patient optimization, which involves making sure the patient is in optimal health before surgery.
  • Donor‐Recipient Matching: Consideration of interactions between donor, graft, and recipient characteristics is essential to achieve the best results following liver transplantation. Better matching of the donor organ to the recipient will enhance transplant outcomes and benefit the waiting list as a whole by reducing graft failure (tissue that is immediately transplanted and keeps growing and living in its new environment) and the need for re-transplantation within the patients waiting for liver transplants.
  • Intraoperative Considerations: During surgery the surgeons should always opt for a procedure that has better outcomes. With better surgical results, many transplant facilities are choosing to execute the cava-preserving "piggyback" procedure, or a modified version of it, which has led to an evolution in liver transplant surgical technique that showed improved surgical outcomes.
  • Utilization of latest technical advancements: Making use of latest technologies to monitor patients and grafts continuously in order to promote early recovery and handle complications.

These factors need to be carefully considered and planned for by the surgical team as they are vital to the liver transplant's success. However, each situation is unique and may require additional considerations depending on the demands and health of the patient.

Treatment of liver failure

When the precise etiology of liver failure is understood, appropriate treatment is administered, along with supportive care, preventive measures, management of complications, assessment of the prognosis, and eventual liver transplantation if necessary. Everyone who receives medical attention needs to be admitted to a hospital, ideally one with the resources and experience necessary for a liver transplant.


Supportive care for liver failure

  • Access hemodynamic stability and the requirement for intravenous fluids, as well as the maintenance of normal acid-base levels and electrolytes. Vasopressors are used to maintain a mean arterial pressure of 75 mm Hg or above in order to ensure adequate renal and cerebral blood flow.
  • Patients with coagulopathy and low platelet functions should have their haematocrit closely monitored for any bleeding. In patients with active bleeding or prior to an invasive operation, platelet-derived blood products and fresh frozen plasma are appropriate for coagulopathy. The prevention of gastrointestinal bleeding should be initiated empirically in patients using proton pump inhibitors.
  • When necessary, begin empirical antibiotics and consider a fever workup that includes blood and urine cultures.


Treatment of liver failure with known cause

Since no specific antivirals are known to be helpful, patients with liver failure coupled with hepatitis A and E should get supportive care. Nucleotide analogues should be administered to patients who have acute or reactivated hepatitis B. Intravenous steroids could be beneficial for patients with suspected autoimmune hepatitis. Gastric lavage, activated charcoal, and intravenous antibiotics could be given to patients who exhibit symptoms of probable mushroom poisoning.


Liver transplantation should be considered for patients whose cause is known to be hepatic vein thrombosis or Wilson disease (copper accumulation in the liver). Anticoagulation therapy and Transjugular intrahepatic portosystemic shunt (TIPS) placement should be given consideration for those with Budd-Chiari syndrome (blockage in the hepatic veins).


It is advised to deliver the foetus as soon as possible in pregnant women with liver failure, which is most likely caused by HELLP syndrome or the acute fatty liver of pregnancy. If the liver failure does not improve, liver transplantation is taken into consideration.


Management of complications of liver failure

  • Kidney failure: The causes of kidney failure could be hepatorenal syndrome (kidney damage due to severe liver disease), hypovolemia (low extracellular fluid volume) or acute tubular necrosis (damage to tubular cells of kidneys). Serious hypotension should be treated with cardiac stimulants.
  • Complications such as sepsis, aspiration pneumonia etc. are managed by broad spectrum antibiotics.
  • Metabolic disorders such as hypoglycaemia and hypophosphatemia could be treated by intravenous fluids and electrolyte replenishers. 
  • One important aspect of liver failure is encephalopathy. When a patient has grade 3 encephalopathy or above, a computed tomography scan of the head should be performed to check for cerebral oedema (brain swelling) and intracranial haemorrhage (bleeding inside brain) and treat accordingly.
  • Complications related to coagulation could be treated by platelet transfusion, or anticoagulation therapy.


Liver transplantation 

In most of the cases of liver failure, liver transplantation is the one and only life-saving surgical intervention with acceptable results. Candidate identification, the ideal transplant window, and possible liver graft prioritizing are important parts of liver transplantation.

The aftermath

In the hospital

Following the liver transplant, patient will be shifted to intensive care unit (ICU) after spending several hours in the recovery room. For a few days, the patient will be under constant observation in the intensive care unit. It's quite likely that a patient may be inserted with a tube in the throat. This is done to make patient breath with the assistance of a ventilator until he/her can breathe on their own. Depending on the circumstances, the patients could require the breathing tube for a few hours or several days.


To eliminate the air that a patient ingests, a tiny plastic tube may be put through the nose and into the stomach. When regular bowel movements resume, the tube will be removed. Until the tube is taken out, the patient isn’t allowed to eat or drink.


Blood samples are frequently taken to evaluate the proper functioning of newly transplanted liver as well as kidneys, lungs, and circulatory system. Patients may be administered with antibiotics and anti-graft rejection medicine and are closely monitored to ensure right dose and right combination of medicine.


Under the surveillance of hepatologist the patient may be shifted from ICU to private room where the patient is made to walk and eat solid foods.


At home

The patient should maintain the surgery site dry and clean after getting to home. He/she will receive special bathing instructions from the hepatologist. Left over stiches, will be removed on next hospital visit. The patient is recommended to keep the surgery site dry and clean after discharge. Bathing should be done according to the instructions provided by the hepatologist.


Consultation of hepatologist is mandatory if the patient experience symptoms such as fever, redness, pain around the surgery site, vomiting, diarrhoea, yellowish discolouration of eyes (jaundice) etc.

Frequently asked questions (FAQs) on Liver failure:

  • How long can someone live with liver failure?

    A liver transplant can considerably improve the prognosis for patients with liver failure.

    Without treatment, the average survival time decreases, and it is difficult to predict how long a person will live with end-stage liver disease because it varies depending on the individual. However, patients with liver failure complications have a mean survival time of 30 days to one year, depending on the patient.

  • What is the most effective treatment for liver failure?

    Liver transplant is the only treatment that has shown promise in individuals with poor prognostic characteristics. In patients with other conditions, rigorous intensive medical care has been shown to save a significant percentage of patients.

  • Can a patient recover from liver failure?

    Yes. With the available advanced surgical and medical interventions, the patients' liver can return to normal function if they adhere to therapy guidelines.

  • At what stage of liver disease, liver transplantation is needed?

    Liver transplantation is advised at end stage liver disease when acute liver failure or chronic liver disease cause liver damage that cannot be repaired or reversed with medical treatments.

What self-care one should follow to stay away from liver failure?

To avoid liver disorders, one should strictly adhere to things such as:

  • Alcohol abstinence: Consuming heavy amounts of alcohol cause fatty liver which eventually damage the liver cells; hence alcohol abstinence is mandatory to maintain a healthy liver.
  • Prevention of hepatis A, B, C viruses: Hepatitis viruses that can damage liver health can be prevented by vaccination, practicing safe intercourse, and maintaining proper hygiene.
  • Be cautious when using medications and herbs: It is demonstrated that certain medications and herbs may cause liver toxicity. So being vigilant in terms of drugs use is necessary.
  • Work out and eat healthy: Avoid obesity to prevent fatty liver disease.

What are the tests that confirms liver failure?

A single diagnostic test cannot confirm the diagnosis of liver failure. Several tests are performed to evaluate liver function and establish the existence and severity of liver failure before making a diagnosis which include:

  • liver function tests
  • Imaging tests such as abdominal ultrasound and CT, MRI scans
  • International Normalized Ratio (INR)

What is the life expectancy after a liver transplant?

After receiving a liver transplant, over 90% of recipients survive for a year, over 80% do survive after five years, and many go on to live for 20 years or more. After a year, the survival rate is 87%, and after five years, it is 73%.

How does liver failure cause renal failure (kidney failure)?

People with advanced liver diseases such as liver failure could manifest hepatorenal syndrome (HRS) as a complication.  Hepatorenal syndrome is a multiorgan condition that could rapidly deteriorate kidney function. The first correlation between liver disease and renal failure was first found in the late 1800s. Additional studies conducted in the middle to late 1900s demonstrated that advanced liver disease-related to renal failure was functional.

What are the possible risks of liver transplantation?

Main risks of a liver transplant include:

  • Following a liver transplant, infections and problems with the bile duct are frequent.
  • Strong medications will be necessary to suppress the immune system, which might cause adverse reactions in the body
  • Bleeding and infection
  • Additional surgery may be required in case of a graft rejection

What are the possible complications of liver transplant?

A 2023 study demonstrated that people undergone liver transplant may have complications such as 

  • Primary graft dysfunction
  • Rejection of the graft 
  • Post-transplant infections
  • Metabolic syndrome 
  • kidney disease and hyperuricemia 
  • Bone complications 
  • Dermatologic non oncological complications
  • Recurrence of viral hepatitis, autoimmune hepatitis (IH) primary biliary cirrhosis (PBC)
  • De novo malignancies etc.

How much does Liver failure treatment cost in Hyderabad?

The cost of liver failure treatment in Hyderabad, India, can depend on several factors, including the type of advanced treatment required, the hospital stay, the severity of the liver disease, the specific healthcare facility, and the patient's insurance or TPA coverage.

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