Dr. Rohit Mehtani: Medicine has always been more than a profession for me. During my childhood, I watched my maternal uncle care for patients with dedication and empathy, and I was inspired by the respect and affection he received. This motivated me to pursue a career in medicine where I could contribute meaningfully to society.
After completing my post-graduation, I joined the Institute of Liver and Biliary Sciences (ILBS) as a Senior Resident under Prof. S.K. Sarin, whose mentorship was instrumental in shaping my clinical foundation.

Dr. Rohit Mehtani: My journey led me to PGIMER Chandigarh, where I began my DM in Hepatology in January 2019, an experience I consider pivotal in defining my identity as a clinician. The institution fostered academic rigor, multidisciplinary collaboration, and a deep respect for evidence-based care. I remain grateful to my mentors - Prof. Dhiman, Prof. Virendra Singh, Prof. Duseja, Dr. Taneja, Dr. Madhumita, Dr. Nipun, Dr. Arka, and Dr. Sahaj - for their invaluable guidance.

Dr. Rohit Mehtani: My pursuit of specialized training in transplant hepatology brought me to Max Superspecialty Hospital, Saket, under the leadership of Dr. Sanjiv Saigal and Dr. Subhash Gupta. The transformative impact of liver transplantation, witnessing patients with end-stage disease return to vibrant, healthy lives reaffirmed my dedication to advanced liver care.

Dr. Rohit Mehtani: Currently, at Amrita Hospital, I’m privileged to integrate clinical practice with academic mentorship in a setting that truly values multidisciplinary collaboration.

Dr. Rohit Mehtani: The most common liver diseases I see are fatty liver disease, now known as steatotic liver disease, whether due to alcohol or secondary to metabolic dysfunction.

This is followed by chronic viral hepatitis, secondary to Hepatitis B and C. Since Amrita Hospital is a tertiary care referral center, we also see a fair number of rare liver diseases like autoimmune hepatitis, primary biliary cholangitis, Wilson’s disease, primary sclerosing cholangitis, hemochromatosis, and vascular liver disorders.

My hepatology practice involves treating the whole spectrum of liver disease from chronic hepatitis to cirrhosis and portal hypertension-related complications, hepatocellular carcinoma, and following up with patients after liver transplant.

Dr. Rohit Mehtani: Currently, we are in a transition phase, during which liver diseases due to Hepatitis B and C are on the decline, while diseases secondary to harmful alcohol use and metabolic dysfunction (obesity, diabetes, dyslipidemia, hypertension) are on the rise.

Dr. Rohit Mehtani: Counseling patients for transplantation requires clarity, compassion, and a strong understanding of their unique clinical trajectory. Another factor that needs to be considered in India is the socio-economic condition of the patient, as most healthcare costs in India are out-of-pocket expenditures. The patients and their family members are thoroughly explained the nature of their condition and prognosis - both short-term and long-term.

Optimized medical management for various complications of liver disease is continued.

Many times, treating the etiology of liver disease leads to significant improvement in liver function, such that transplant can be avoided or delayed. However, liver transplantation is never presented as the last option. It is a potentially life-saving and transformative intervention.

Candidacy for transplant is assessed early, and all treatment options are discussed with the patient, who is informed about the pros and cons of each. I strongly believe that we as physicians should empower the patient and their families rather than just informing the patient about the doctor’s decision.

Dr. Rohit Mehtani: Liver transplant in adults is mostly needed due to complications of end-stage liver disease or cirrhosis. Other indications include acute liver failure, hepatocellular carcinoma, metabolic liver diseases (such as Wilson’s disease, hereditary hemochromatosis, etc.), and primary cholestatic liver disorders (primary biliary cholangitis, primary sclerosing cholangitis).

Dr. Rohit Mehtani: The decision for liver transplant is based on standard criteria like the MELD (Model for End-Stage Liver Disease) score. Patients with cirrhosis and a MELD score >15 are considered for liver transplant. There are a few MELD exceptions like liver cancer and hepatopulmonary syndrome, which are indications for transplant even if the MELD score is <15.

Prior to transplant, the fitness of the recipient to undergo the surgery is assessed by a multidisciplinary team of cardiologists, pulmonologists, anesthetists, and psychiatrists.

Patients with multi-organ failure, active uncontrolled infections, or extrahepatic malignancies are usually not considered candidates for transplant. In India, there are two types of liver transplant — live donor liver transplant (LDLT) and deceased donor liver transplant (DDLT). In live donor liver transplant, the liver donor must be a family member of the recipient. In deceased donor liver transplant, the donor is unrelated to the recipient.

Dr. Rohit Mehtani: One of the most common misconceptions we face in daily clinical practice is regarding the risks of donor surgery. Although donor surgery is a major operation, strict criteria for donor evaluation are followed to prevent complications. Most donors, after recovery, can lead a healthy life.

Another common misconception recipients have is that after a transplant they will be confined to their homes and not be able to travel. This is not the case, and most recipients return to work, travel, and even start families.

Dr. Rohit Mehtani: One of the most significant advances in liver transplantation has been the integration of minimally invasive (robotic/laparoscopic) techniques. It started with robotic donor hepatectomies, and now a few centers in the West have even started complete robotic liver transplants, with both donor and recipient surgeries carried out robotically. This has led to a reduction in post-operative pain and shorter ICU and hospital stays for patients.

Dr. Rohit Mehtani: Post-transplant care is where the real journey begins and is often more complex than the transplant surgery itself. Balancing rejection risk and infection risk with careful titration of immunosuppression is a major challenge in the post-transplant period. Then there are long-term complications of immunosuppression like metabolic dysfunction, renal dysfunction, and malignancies, which can be minimized by keeping the immunosuppression to the lowest dose needed to prevent graft rejection. Long-term success is ensured by educating the patient about these anticipated complications and ensuring regular surveillance and monitoring.

Dr. Rohit Mehtani: The most specific symptoms of chronic liver disease are jaundice (yellowish discoloration of eyes and urine), ascites (fluid accumulation in the abdomen), blood in vomitus, and altered mentation.

Dr. Rohit Mehtani: Screening for hepatitis is crucial for early detection and treatment. For Hepatitis B, screening tests include HBsAg, and for Hepatitis C, the screening test is anti-HCV antibody. High-risk individuals include healthcare workers, people who inject drugs, patients on dialysis, individuals with HIV, and those with persistently elevated liver enzymes. Pregnant women should also be screened for Hepatitis B and C. Tailored protocols based on patient risk profiles ensure effective prevention and timely care.

Dr. Rohit Mehtani: Acute-on-chronic liver failure (ACLF) represents a critical and rapidly progressive form of liver disease characterized by multi-organ dysfunction and a high short-term mortality risk. Patients are often critically ill and require intensive care support. One of its major complications is hepatic encephalopathy, seen in both ACLF and decompensated cirrhosis, where neurocognitive function deteriorates due to elevated circulating toxins. Early signs include disorientation and reduced attention span, which can advance to stupor or coma if not promptly managed.

Dr. Rohit Mehtani: Neuromonitoring protocols are vital tools for evaluating cerebral function in critically ill patients, especially those at risk for hepatic encephalopathy. Given its association with increased morbidity and mortality, early detection and timely intervention are essential for improving patient outcomes. In our review article, we explore contemporary strategies for early recognition and outline practical, evidence-based steps that clinicians can implement to enhance the care of these vulnerable individuals.

Dr. Rohit Mehtani: Community education has the potential to reduce the burden of hepatitis by promoting early screening, increasing vaccine uptake, and dispelling myths around transmission and treatment. It encourages high-risk groups to seek care and normalizes open dialogue about liver health.

Dr. Rohit Mehtani: India is already a leader in living donor liver transplants. The future of hepatology in India is set to thrive on multidisciplinary care, artificial intelligence-driven diagnostics, and robotic precision in liver transplants. Innovations like bioengineered livers and stem cell therapies may redefine treatment strategies in the future.

Dr. Rohit Mehtani: One of the most memorable cases in my hepatology practice involved a patient with advanced decompensated cirrhosis and renal dysfunction, initially being evaluated for liver transplantation. Unfortunately, a suitable donor was unavailable, so we continued with optimized medical management.

Over time, the patient began showing signs of clinical improvement, and we proceeded with a transjugular intrahepatic portosystemic shunt (TIPSS) to alleviate portal hypertension.

Remarkably, one year post-procedure, the patient remains clinically stable, with normalized liver function and complete resolution of ascites, a testament to the potential of multidisciplinary, non-transplant approaches in carefully selected cases.

Dr. Rohit Mehtani: For young professionals, hepatology offers the chance to impact lives through complex decision-making, multidisciplinary collaboration, and innovations like liver transplantation and regenerative medicine. If you're drawn to solving intricate puzzles and advocating for vulnerable patients, hepatology will challenge and inspire you every day.

Dr. Rohit Mehtani: To maintain liver health, one should eat a nutritious, fiber-rich diet and avoid excessive sugar, fats, processed foods, and alcohol. Stay active with regular exercise and keep yourself hydrated. Avoid unnecessary medications, including complementary and alternative medicine. Get vaccinated for hepatitis and practice safe hygiene to prevent infections. Even small lifestyle tweaks can offer powerful protection over time.