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Dr Venkatesh on Liver Transplant for Wilson’s Disease: A Metabolic Cure
Dr Venkatesh BS/LinkedIn
Nov 17, 2025, 05:29

Dr Venkatesh on Liver Transplant for Wilson’s Disease: A Metabolic Cure

Dr Venkatesh BS, Transplant Surgeon at CareVue Health, posted on LinkedIn:

“Liver Transplant in Wilson’s Disease (WD): resetting copper metabolism and rewriting fate.

Wilson’s is one of those rare diseases where a transplant doesn’t just save a liver, it cures the metabolic defect. Yet, timing is everything. Miss it, and copper wins.

Indications

1. Acute Liver Failure (ALF): The “no-delay” zone.
• Encephalopathy + acute hepatic failure
• Rapid bilirubin rise (>20 mg/dL) + INR >2.0
• Modified King’s College criteria: AST:ALT > 2.2, bilirubin > 5.8 mg/dL, INR > 1.5
→ Without LT, mortality >90%.

2. Chronic WD / Decompensated Cirrhosis
• Ascites, variceal bleed, jaundice, encephalopathy despite optimal chelation
• MELD > 15-18 or Child-Pugh C

3. Neurological WD (the grey zone)
• Progressive neurological decline despite ≥6- 12 months of therapy
• 70- 85% improve post LT if done before irreversible damage
→ Early MDT (hepatology + neurology) is key.

The Challenges

Diagnosis can be deceptive, low ceruloplasmin may look “normal” in ALF, and hemolysis clouds the picture.
Selecting neuro-WD candidates demands balance: who will benefit neurologically versus who may not recover even with a new liver.

And perioperatively? Infection and cerebral edema are still the villains of early mortality. Meticulous critical care saves more lives than heroics.

Outcomes
• 1-year survival: 85-92%
• 5-year survival: ~80%
• Neurological improvement: ~75-85%
• Recurrence: None. WD is metabolically cured
• Main early causes of death: Sepsis, cerebral edema

The 2025 EASL-ERN update makes it simple:

Encephalopathy in WD-associated ALF = urgent transplant.
No encephalopathy? Use established prognostic tools (like King’s).

Translation: Don’t wait for “more evidence” when the copper crisis hits the brain.

Key Takeaway

When Wilson’s turns toxic, the clock ticks fast.
Transplantation doesn’t just restore hepatic function, it reprograms copper biology, often reversing neurological chaos and saving lives.

Copper may be ancient currency, but in the wrong hands, it bankrupts the liver. Thankfully, transplantation writes the ultimate balance sheet a metabolic reset and a new life.”

Dr Venkatesh on Liver Transplant for Wilson's Disease: A Metabolic Cure

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Acute Liver Failure (ALF) ceruloplasmin Decompensated Cirrhosis Dr Venkatesh BS Health Hematology Hemostasis Hemostasis Today Medicine Wilson’s Disease (WD)
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