Key points
- Cirrhosis has two broad phases: compensated (the liver is scarred but still coping) and decompensated (ascites, variceal bleeding, confusion or jaundice have appeared).
- Treating the cause — stopping alcohol, curing hepatitis C, suppressing hepatitis B, losing weight — is the single most useful step at any stage.
- Everyone with cirrhosis needs an ultrasound every six months to look for early liver cancer, and an endoscopy to check for varices.
- The first episode of decompensation, or a MELD score of around 15 or more, is the usual point to be assessed for a liver transplant.
What cirrhosis means
When liver cells are injured again and again, the liver repairs itself with scar tissue (fibrosis). Over time the scars link up and divide the liver into hard nodules. This distorted structure is cirrhosis. Two things follow: the liver has fewer working cells to make proteins, clear toxins and process bilirubin, and blood struggles to pass through the stiff liver, raising the pressure in the portal vein (portal hypertension).
Most complications of cirrhosis come from one of these two problems — loss of liver function or portal hypertension. Understanding which one is driving a patient's symptoms helps explain the treatment.
Common causes of cirrhosis in India
Alcohol →
Long-term heavy drinking remains one of the commonest causes in eastern India. See alcohol-related liver disease.
Hepatitis B and C →
Chronic viral infection, often silent for decades. Both are now treatable. See hepatitis B and C.
Fatty liver (MASLD) →
Linked to diabetes, obesity and central weight gain — a fast-growing cause. See fatty liver disease.
Autoimmune and genetic diseases →
Autoimmune hepatitis, PBC, PSC and Wilson disease, among others. See autoimmune and genetic liver disease.
In some patients no cause is found despite full testing (cryptogenic cirrhosis); many of these are thought to be burnt-out fatty liver disease. Often more than one cause is present — for example alcohol together with diabetes and fatty liver — and each needs to be addressed.
Compensated and decompensated cirrhosis
| Compensated cirrhosis | Decompensated cirrhosis | |
|---|---|---|
| What it means | The liver is scarred but still does its essential work | The liver can no longer keep up, and major complications have appeared |
| Typical symptoms | Often none; perhaps tiredness or a low platelet count found on a routine test | Ascites, variceal bleeding, hepatic encephalopathy or jaundice |
| Outlook | Many people remain stable for years, especially if the cause is controlled | Outlook is much shorter without a transplant; this is the stage to be assessed |
| Main goals | Treat the cause, prevent first bleeding, screen for cancer | Manage complications and plan for transplant evaluation |
Widely published studies describe survival in compensated cirrhosis in terms of a decade or more, falling to a few years once decompensation begins. These are averages across large groups; an individual's course depends heavily on whether the cause can be removed.
Child-Pugh and MELD scores in plain words
Doctors use two scores to describe how severe cirrhosis is. Neither is a test in itself — both are calculated from routine blood reports and the clinical picture.
- Child-Pugh class (A, B or C) combines bilirubin, albumin, INR (clotting), the amount of ascites and the degree of confusion. Class A is well-preserved liver function; class C is advanced. It is useful at the bedside and for deciding whether liver surgery or some cancer treatments are safe.
- MELD score is calculated from bilirubin, INR and creatinine (kidney function), and in its current form also sodium. It ranges from 6 upwards to 40; the higher the number, the higher the short-term risk of dying without a transplant. MELD is what transplant programmes use to judge urgency — see liver transplant evaluation.
Watch the trend, not one number
A single MELD value can be pushed up by dehydration, infection or a diuretic dose. A score that keeps rising over several weeks is more meaningful and is a reason to see a transplant team.
Complications to know about
- Ascites — fluid in the abdomen, which can become infected (spontaneous bacterial peritonitis).
- Varices — swollen veins in the food pipe or stomach that can bleed suddenly and heavily.
- Hepatic encephalopathy — confusion, sleep reversal or drowsiness from toxins the liver cannot clear.
- Kidney failure (hepatorenal syndrome) — the kidneys shut down in response to advanced liver disease.
- Liver cancer (hepatocellular carcinoma) — the risk is substantially higher in cirrhosis. See liver cancer surgery.
- Muscle wasting and malnutrition — common, often unnoticed, and linked to worse outcomes, including after transplant.
Go to hospital the same day if someone with cirrhosis has:
vomiting of blood or black, tarry stools; new confusion, excessive sleepiness or unusual behaviour; fever with abdominal pain or a rapidly swelling abdomen; very little urine; or deepening jaundice. These can mean bleeding, infection, encephalopathy or kidney failure, and all can worsen within hours.
What treatment can and cannot do
Medical treatment of cirrhosis is usually led by a hepatologist or gastroenterologist. It works on three fronts:
- 1
Remove or control the cause
Complete abstinence from alcohol; antiviral treatment for hepatitis B or C; weight loss and diabetes control for fatty liver; specific medicines for autoimmune or Wilson disease. In early cirrhosis this can lead to meaningful improvement, and some decompensated patients recover enough to come off the transplant list.
- 2
Prevent and treat complications
Beta-blockers or endoscopic band ligation to reduce the risk of variceal bleeding; salt restriction and diuretics for ascites; lactulose and rifaximin for encephalopathy; antibiotics where infection risk is high.
- 3
Protect the liver and body
Adequate protein (patients with cirrhosis should not cut protein), a late-evening snack, vaccination against hepatitis A and B, and avoiding painkillers such as ibuprofen and diclofenac, unprescribed herbal products and sedatives.
What treatment cannot do is reliably reverse established, advanced cirrhosis or restore a liver that has failed. No tonic, supplement or "liver detox" repairs cirrhosis. When the liver can no longer sustain life, liver transplantation is the only curative treatment. In selected patients with portal hypertension that does not respond to medical and endoscopic treatment, a TIPS procedure or portal hypertension surgery may be considered.
Six-monthly screening for liver cancer
Liver cancer in cirrhosis often causes no symptoms until it is large. Found early — as a small tumour on a routine scan — it can often be treated with surgery, ablation or transplant. For this reason international guidelines recommend an abdominal ultrasound every six months, often with a blood AFP level, for everyone with cirrhosis, even if they feel well and even after the cause has been treated. If ultrasound views are poor, a CT or MRI may be used instead.
When to be referred for a liver transplant
- A first episode of ascites, variceal bleeding, encephalopathy or jaundice.
- A MELD score of around 15 or higher, or a steadily rising score.
- Ascites that keeps returning despite medicines, or repeated large-volume taps.
- Liver cancer found on surveillance that may be treatable with a transplant.
- Kidney impairment related to liver disease, or a poor quality of life from itching, fatigue or encephalopathy.
Referral is not a decision to operate — it starts an assessment of whether a transplant is needed now, later or not at all, and whether a family member could be a living donor. Early referral gives time to plan; late referral, when the patient is already in intensive care, narrows the options. Dr Bappaditya Har sees patients with cirrhosis at Narayana RN Tagore Hospital, Mukundapur, Kolkata, and families from Bihar, Jharkhand, Odisha, Assam and Bangladesh can send reports on WhatsApp (+91 70420 39420) before travelling. To book, call 080675 06860.
Frequently asked questions
Can liver cirrhosis be cured?
Established cirrhosis cannot usually be undone by medicines, but treating the cause can stop it from progressing and sometimes improve liver function considerably. For a liver that has failed, a liver transplant is the only cure.
How long can a person live with cirrhosis?
It varies widely. People with compensated cirrhosis whose cause is controlled can live for many years. Once complications such as ascites or bleeding appear, the outlook becomes much shorter without a transplant, which is why that is the point to be assessed.
What should a cirrhosis patient eat?
A balanced diet with enough protein, spread over small frequent meals including a late-evening snack, with limited added salt if there is ascites. Strict protein restriction is outdated and causes muscle loss. Alcohol must be stopped completely.
Which painkiller is safe in cirrhosis?
Paracetamol in modest doses, as advised by your doctor, is generally preferred. Anti-inflammatory painkillers such as ibuprofen, diclofenac and aspirin can cause kidney failure and bleeding in cirrhosis and should be avoided.
Is a FibroScan enough to diagnose cirrhosis?
A FibroScan measures liver stiffness and is very useful, but results can be affected by food, inflammation or congestion. The diagnosis is made by combining it with blood tests, imaging and, occasionally, a biopsy.
Do I need a transplant if I have cirrhosis?
Not necessarily. Many people with compensated cirrhosis never need one. A transplant is considered when the liver starts to fail, when MELD rises, or when liver cancer develops within treatable limits. The cost page explains the financial planning involved.
Related reading
Liver Failure Treatment →
Acute and chronic liver failure, and when transplant is needed.
Ascites: Fluid in the Abdomen — Causes, Treatment and When It Means Transplant →
Fluid in the abdomen is usually a sign of advanced cirrhosis. Learn the causes, the tap test, salt limits, diuretics, tapping and when transplant helps.
Liver Transplant Evaluation: Who Needs It, MELD Scores and the Tests →
Who needs a liver transplant, what MELD and PELD scores mean, the tests in a transplant work-up, reasons transplant may not be possible, and what to bring.
Liver Cancer Surgery →
Surgery and transplant for hepatocellular carcinoma and liver tumours.
Liver Transplant in Kolkata →
Evaluation, surgery and recovery — the complete transplant pathway.
This page is general patient information, not a diagnosis or a substitute for a consultation. Treatment decisions depend on each patient's reports and examination. Read our medical disclaimer and editorial policy.