The MELD Score and Liver Transplant: An Update for Patients

Liver Transplant

Patients awaiting transplant commonly have questions regarding there MELD score, and how this number is determined. As you can imagine, there is great anxiety in patients awaiting transplant. At almost every clinic visit, patients are asking for they’re updated score. In my own practice, at every visit we calculate the new score and discussed this result with them. The MELD score, which we have been using for the past several years, is calculated by taking the patient’s most recent bilirubin, creatinine, and INR, which is then entered into the computer and calculated. Theoretically, the MELD score can arrange in values between 5 and 40. It has generally been accepted that patients with a MELD score less than 15 have a better survival is not transplanted. Those with scores over 15 should be considered for transplant. The higher the MELD score, the more ill the patient is, with a greater likelihood of not surviving. In the greater Houston area, most of the transplant programs, including ours at the Methodist Hospital, are transplanting  patients with MELD score is greater than 25.

There are certain exceptions to the MELD score. Many of these are developed regionally. With patients who develop hepatocellular carcinoma, in most cases, they will receive a MELD exception of 22 points, even if they have a lower calculated score as described above. It’s been well established that patients with liver cancer should be transplanted quickly. This MELD exception allows this to take place. If after 3 months the patient is not transplanted, additional points are granted. Other MELD exceptions for pulmonary hypertension, refractory gastrointestinal bleeding, and refractory ascites are also allowed. These are given on a case by case basis after a regional review by other transplant centers. Not every exception is granted, and this could be another source of anxiety for patients and their family.

Looking at the bilirubin, creatinine, and INR, you could see that as the patient becomes more ill, their MELD score will reflect a higher value. It is very difficult to sit with the patient who has a low MELD score, who happens to feel very ill, and tells him that they must continue to get even more debilitated before a transplant is performed. While the current allocations system works for the vast majority of patients, there are always going to be those patients that have a MELD score that does not accurately represent how sick they are. For these patients, this is where most of the anxiety and concern is present. The best that we can do as physicians and other healthcare providers is to reassure them and worked very closely with them. I personally have been involved in liver transplantation for over 20 years, and the same issues we faced 20 years ago, despite a different allocations system, remained today.

To calculate your own MELD score, I have listed a link below. Of course, if you have any questions, feel free to contact me or post your comments on this blog for others to see and learn from. You can always reach me at Liver Specialists of Texas at 713-794-07 00.

Calculate your MELD score here

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55 Responses to “The MELD Score and Liver Transplant: An Update for Patients”

  1. Lori 05/26/2011 at 8:29 am #

    Can a person with stage 4 chirosis Meld score go down? My husband did have a Meld Score of 11 now they said it is a 5. Is that possible?

    Thank you,
    Lori

    • Dr. Joe Galati 05/29/2011 at 11:44 am #

      It can indeed. Based on the values of the creatinine (kidney function), bilirubin, and INR (clotting time of the blood), all have the potential to change based on how sick (or well) a patient is. I have seen very stable patients waiting for transplant have stable MELD scores in the low to mid teens (15-17), who experience a severe case of peritonitis, or have a massive variceal hemorrhage. Instantly, their MELD score shoots up to the high 20′s or 30′s due to acute kidney failure (rise in creatine), and an increase in the INR. Similarly, these patients can recover, and get back to their baseline values, and continue to do pretty well. Hope this explains your question.

  2. Madhav 06/03/2011 at 3:59 pm #

    My father 63 years, had heart bypass surgery in 2002, has been diabetic since 20 years, has never consumed alcohol, has tested negative for Hep A and B and C. No Liver Cancer. has been diagnosed with decompensated cirrhosis. +++ is what doctors have written. the cretanine is 0.91, and the billurbin total is 0.5 (jendrassik-Grof) and the Prothrombin time is TEST 14.9 SECONDS, CONTROL 12.0 SECONDS, INR 1.26., Sodium (Na)ISE 127.9, Albumin 2.5 g/dl, Ascitic Fluid-Albumin 1.2 g/dl. THE FIBROSCAN SHOWS stiffness 26.6 (KPa), IQR 4.1 (KPa), CS 27.7 KPa, Sucess Rate 91%. I am based in New Delhi, India. My problem is doctors here just told us Liver Transplant is the only way. He has fluid retention in abdomen, edema, does not feel hungry, is constipated. Doctors here are not telling me in lay mans term what is the problem. whether his condition is so serious that he can not survive for more than a couple of months without transplant, as we can not afford the cost of transplant. I am begging you to please let me know where i stand ? i HAVE ALL REPORTS, ct scan, endoscopy, fibroscan, liver bioposy, his hVPG is 16. can you please help and tell me. If you want any other test done, or reports please let me know. but please help.

    • Dr. Joe Galati 06/05/2011 at 10:37 pm #

      It seems that liver transplant is something that needs to be considered. Of course, there are a number of issues that need to be addressed, including his cardiac status. Diabetes for 20 years and prior heart surgery needs to be looked at very carefully.

      Are they considering transplant in India? Coming to Houston is always an option, thought there are logistical issues that need to be sorted out.

      Unfortunately without transplant, many patients continue to have complications related to their underlying liver disease.

    • Anonymous 06/02/2013 at 6:55 am #

      Hi Madhav,

      My father is in a somewhat similar situation. Doctors in New Delhi do not follow medical ethics at all. It seems their only concern is to make money and sell the most expensive treatment to the patients.

      The best surgeons at Medanta (including A.S. Soin), Dr. Sarin at ILBS, and Dr. Subhash Gupta at Apollo. All these guys just wanted to sell a transplant to my father and suggested we go in for a living transplant as soon as logistically possible. This was quite disturbing.

      We met Dr. Rajasekar from Chennai and he was the first one to talk to us in length about our fathers reports in details. He explained everything to us and told us just on the basis of some inconclusive results you cannot and should not go in for a transplant since that is a major surgery. He advised us to wait and repeat the CT scan after 3 months to confirm if the HCC is in fact present in my fathers case. Current reports were only suggestive of faint signs of HCC. We have realized that doctors in Delhi are so business minded that for profit they have no qualms in even cutting open a perfectly healthy living donor. On the other hand all of these doctors are qualified surgeons. They would indeed do a great job in case a surgery is actually necessary. But the quest for making money has led these guys on the wrong track.

      It is unfortunate, but that is the truth. In case you are not well educated and are not in a position to make an informed decision, I feel that these doctors would just squeeze the last drop of life from you by making you pay through your nose, exposing you to unnecessary radition in terms of various imaging and getting you to run around the hospitals to deal with their rude staff and further deteriorate your health.

  3. Daniel Stelle 07/21/2011 at 1:22 am #

    My dad got a call yesterday about his Meld score and it jumped from 18 – 25. I am not very familiar with the meld score system and what it means. They told him that if he starts bleeding from the mouth or nose to go straight to the ER asap. Why?

  4. Tammi White 12/16/2011 at 4:13 pm #

    Dr. Galati

    I’m emailing you in reference to my Brother. He contracted Hep C sometime ago and has never received treatment or has have a live biop. I’m interested in the clinical trial GS-585, GS-9451 w/ Peginterferon Alfa 2a (PEG) and Ribavirin. I also have read information about the FibroScan but don’t know where to have one done. He is unemployed and uninsured that is why we are looking for a clinical trial. If you can assist me and maybe direct me to where we can go to have this scan I would GREATLY appreciate it.

    Tammi

    • Dr. Joe Galati 12/19/2011 at 10:49 pm #

      There are a number of very interesting compounds being developed, as we discuss. Depending on the part of the country your brother lives, opportunities exist. If in Texas, we’d be more than happy to evaluate for a study. You can call our office at 713-794-0700 and speak with Herman Ortiz for details. Good luck. Dr. Galati

  5. Tammi White 12/20/2011 at 1:44 pm #

    Dr. Galati,

    Thank you so much. My brother and I are both in Houston. I will call Herman Ortiz now for an appoinment after the holidays. I look forward to meeting you.

    Happy Holidays,
    Tammi

  6. Caroline 12/27/2011 at 12:29 pm #

    Dr. Galati,

    My father has chirosis of the liver and his MELD score was 12-15 now he has been diagnosed with Peptic Renal Failure and his MELD score is 25. WHat exactly does this mean in refernce to the transplant list as far as when he could get a liver? He is at MUSC which is a smaller hospital.

    Thanks again,
    Caroline

    • Dr. Joe Galati 12/30/2011 at 8:17 pm #

      Going into kidney failure, which is a common complication, elevated ones MELD score, since kidney is one of the three factors used to calculate the score. There is also a special option, if the patient has been on dialysis, that will add to the score as well. While these developments increase the MELD score, and thus the chance for transplant, survival, unfortunately, is also reduce. Hope this helps. Dr. Galati

  7. sharon whitworth 01/28/2012 at 6:22 pm #

    My boyfriend has a meld score of 6… he had hep. c but has been cured of the hep. with the 6 month treatment. My mother has a meld score of 11. her cirrhosis is due to fatty tissue. My sister had a meld score of 16, it went down to 15, but when it was a 16, she said she had been put on the transplant list in birmingham al. thats where she lives. she has a different doctor than the other two. my mom’s doc. said he worked at uab for 12 yrs. and there is no way my sister could be put on the list with a 16 meld score. he said it has to be 18 or above. My sister takes medicine for the high ammonia. I’m just trying to figure her story out about the transplant list. I know Doctors oppinions vary. I’m just trying to figure out if my sister is being completely truthful. Can you give me some input? My Mom & boyfriend seem to function fine. But my sister is entirely different. Is it because their meld score is so much lower or is it all in the attitude one takes. My sister is on disability due to her cirrhosis(she was a psychologist,but due to the high ammonia level was no longer able to see patients).She doesn’t want to work anyway, so now she doesn’t have to. Also she is overweight. would they even consider putting her on the list with her being overweight? She said she had to undergo many evaluations & do a stress test to be put on the list. Can you give me some input?

    • Dr. Joe Galati 02/02/2012 at 10:11 pm #

      Many times the MELD score does not reflect how sick a person is with cirrhosis. Every case is different, and transplant programs do different from city to city regarding who they will lace on the list. The best bet is to make sure everyone understand the plan of care outlined by the doctors, and communicate it to rest of the family.

  8. Zubee 02/19/2012 at 9:35 am #

    My husband has alcoholic cirrhosis,since he had bleeding from varices in esophagus,he stopped alcohol completely,it’s been 2 months since the first episode of blood vomiting and he had two more such episodes and his meld score dropped from 14 to 17,why is he not improving inspite of stopping alcohol,is he going to need a liver transplant?

    • Dr. Joe Galati 02/22/2012 at 5:28 am #

      In many cases, after bleeding, the function of the liver continues to get worse, even if they stop bleeding. ANY patient bleeding from varices needs to be evaluated for transplant. If in Texas, I would be pleased to evaluate him for transplant. 713-794-0700.

  9. Alexander 02/27/2012 at 4:36 am #

    Dr G,

    Is age taken into consideration at all?

    I guess because I’m in my 20s with significant liver disease I’m biased.

    MELD doesn’t apply to kids with bilary atresia.

    Cheers, Alexander.

  10. nancy sweeney 04/23/2012 at 8:49 am #

    Dear Dr. G,

    My husband was hospitalized on 9/10/11 with a M.E.L. score of 18 with the hopes of getting on the transplant list. On 9/21/11 he was listed and then removed frm the list on 9/22/11 because his M.E.L. score was 44. He passed away on 9/24/11. Is it unusual for someones score to jump from 18 to 44 within 11 days? What could cause this?

    • Dr. Joe Galati 06/01/2012 at 5:39 pm #

      Sorry for your loss.

      The MELD score can change in a matter of days. We are allowed to upgrade on a daily basis because of this. A worsening MELD is reflective of worsening liver function, and survival.

  11. Steve George 07/03/2012 at 2:59 pm #

    Hi Dr Joe,
    My brother has Liver Disease with a meld score of now 29. he is sick and tired and experiencing heavy swelling/ fluid build up. He’s on the list at UCLA, but since his score is increasing, has just been approved for a transfer to Indiana. There he was assured he’d be moved to the top of the transplant list due to his score and condition. Do you feel this is a good move and can you recommend any advice?
    Thanks so much.
    Steve

  12. Shanti 07/04/2012 at 8:05 am #

    My brother was 42 years old. he was diagnosed with Cirrhosis of liver with portal hypertension. he was admitted to hospital (15th May 2012)as recommended by our family doctor as there was fluid accumulation. The hospital told us that the fluid was very minimal and there was no need to drain. He had a dry cough which used to make him restless specially during evening. On informing the doctor they did an X-ray and told us that his lungs was clear and it was a bronchitis and antibiotic was prescribed. He could not sleep whole night but the nurses refused to call the doctor on call.The one week he stayed in hospital his emotional condition was becoming worse. as only thing the hospital was doing was giving medication and doing we asked for a discharge. Hospital had recommended high protein diet. but they were not providing the same at hospital.the nursing care was very bad. I had a discussion with doctor. they explained that he will have to go for a liver transplant and will discuss with my brother when he comes for review after two weeks.

    As we were getting ready to leave a friend of ours who also works in the same hospital saw my brother coughing and asked if an echo cardiogram was done for him when I told, no ,he went to meet the doctor. When we got the discharge summary it was mentioned that they wanted to do an echo cardiogram. The patient should do the same when he comes for review after two weeks. They had done an ultra sound, upper GI endoscopy and sigmoidscopy. During his stay in hospital or when discussing about his discharge the doctor mention any thing about his heart being affected due to cirrhosis of liver.

    he was discharged on Monday21st May. 22nd night he again had cough like he had during his hospital stay. He could not sleep whole night but he refused to go back to the same hospital. We took appointment with another hospital on Wednesday. He had bath by himself and got ready. to go to hospital. on the way he had a cardiac arrest and passed away.

    Just want to know few things:
    1. if liver cirrhosis affects heart
    2. If an echo was done would the doctors have been able to inform us about the condition better,
    I want these information so that when future anybody has similar condition we can be better aware what to check with the doctors.

    I Know that no Doctor could have stopped my brother from dying as that is decided by God but if we were informed about the risk factors we would have been better prepared. He could have been provided some support so that he would not have to suffer whole night.

  13. Brittny brockwell 07/10/2012 at 8:21 pm #

    My father has been an alcoholic for twenty years. He has cirrosis and has been to the hospital multiple times this year for the vericose veins on his esophogus rupturing. His doctor refered him to a specialist to help him get on the liver transplant list. Does he even qualify for one? Can alcoholics receive liver transplants? They also mentioned him getting a stint put into his heart.

    • Dr. Joe Galati 08/11/2012 at 4:32 pm #

      Alcoholics do qualify for transplant. They must stop all alcohol, and participate in a relapse program such as AA.

  14. Kathy 08/05/2012 at 11:54 pm #

    I live on the west coast, diagnosed with Autoimmune Hepatitus about 14 years ago due to sulfa antibiotics. For many years I was stable up to 2 years ago when my liver started failing. My MELD was 32 at the hospital for 3 weeks. I was put on TP list in the #1 spot and stayed there for 8 months. During which time, became diabetic, hypothyroidism, cataract surgery in both eyes, 2 tumors (1 brain, 1 jaw), and frequent the ER, have ascites, GI bleed, hepatic encephalopathy and skin cancer. My MELD hovers 8-11 and I am told not high enough to be offered a new liver. My quality of life has diminished, constant procedures performed, ER visits, new problems to add to my list of health problems. At what point do I move back up the list where I might be considered for transplant? Or is my fate that I continue to deteriorate, add so many health issues just to keep my liver working, taking medications with serious side effects, that I work myself into a position that I will never be selected as a good transplant candidate? Can you give me any clarity on this?

    • Dr. Joe Galati 08/11/2012 at 4:29 pm #

      This is always a difficult position to be in. Right now, the sickest, with the highest MELD scores, get the donor organs. A MELD such as yours is rather low, but does not fairly reflect the quality of life you describe. Think about dual listing at another program.

  15. Amanda 11/19/2012 at 8:45 pm #

    What does it take to make the list? My dad lives in Alabama, has a MELD count of 15, (he has cirrosis of the liver and diabetes) and while he was doing testing found out he had liver cancer as well. When talking with the drs there, they seemed pretty sure that it was very likely that he would be put on the list and be transplanted quickly. But when getting the paperwork back, he didn’t even make the list and is being asked to do the Ablation procedure. Is this normal to not make the list? If a patient has this Ablation procedure will they then be placed on the list? Sorry, we just aren’t getting any answers and are very worried.

    • Dr. Joe Galati 12/12/2012 at 10:12 pm #

      It’s a long process to get listed, and each program, based on their region of the country, has different rules they go by. You can always seek a second opinion. Happy to evaluate. Give us a call. Dr. Galati

  16. Debbie 12/19/2012 at 9:24 pm #

    My 58 year old sister has end stage cirrhosis. She is being treated with lactulose, but her hallucinations are increasing and she is nauseated and vomiting all day long. She has had fluid drained from her stomach once about 5 months ago. I just read about a drug called xifaxan being used in conjunction with lactulose to reduce the ammonia levels and hallucinations. However, there seems to be a risk of C Diff developing with this drug. The physicians in our small town don’t quite know what to do with her and are just experimenting with drug dosages and trying different drugs. Should she ask dr. to try Xifaxan or some other drug? She is not in the hospital. Should she be?

    • Dr. Joe Galati 01/02/2013 at 9:39 pm #

      It seems at age 58, if there are no other medical conditions, she should be evaluated at a liver transplant program. Xifaxan can be used by itself or in combination with lactulose to control hepatic encephalopathy.

  17. Jacqueline 01/02/2013 at 1:53 am #

    My father was diagnosed with liver cancer in March 2012. He took the mediactions and. participated in clinical trials, but nothing has worked. His doctors have told him he has less than 4 months. As of his last scan, his cancer had not spread. Why is he not a candidate for a transplant?

    • Dr. Joe Galati 01/02/2013 at 9:37 pm #

      Thanks for the note. Liver transplantation is possible in cases of liver cancer, though size and location matters. Has he been seen at a center that deals with liver transplantation and liver cancer. If not, I would seek out an opinion at such a center. Let me know what city he lives in and I can suggest a few options.

  18. hema 01/23/2013 at 8:46 am #

    Hi, Dr. Galati

    My mom diagnosed with HCC, she is on transplant list for 11 months, right now her meld score is 29. her hep c has genotype 3A , and after 4 weeks of treatment the viral load is not detectable, still she is continue the treatment. right now she is on 30 weeks of treatment. her hepatologist said that she has to continue treatment until the liver transplant. the last scan shows there is no melignancy also no any residual disease.
    In case of HCC they said they have trasnplant asap so i would like to know why its take that much time alSo she is O+ve blood group. Her AFP IS 1.5.
    Do you think my mom will benifit if i transfer her care to methodist hospital. also i would like to know if there is any multiple listing availble.
    THANK YOU SO MUCH FOR YOUR HELP.

    • Dr. Joe Galati 01/26/2013 at 3:57 pm #

      It appears that she is receiving appropriate treatment. I assume she is receiving the MELD exception points. The HCV treatment, as long as she is tolerating the treatment, is also a great plan. Would be happy to get her double listed, though with a MELD score of 29, she is very close-depending on where she liver. Happy to assist. Let me know. Dr. Joe Galati

  19. hema 01/31/2013 at 10:41 am #

    Hi, Dr. Galati

    Yes, because My Mom have HCC, she start her MELD score 22, right now her score is 29. she live in Houston, also I would like to know after 28 points, she done the scan in 3 months and she only got 1 more point instead of 3 points so I would like to know how is the MELD Score work after 28 points. And as per last scan report of MRI, There is no malignancy or residuals disease. Mom done chemoembolization IN APRIL 2012 AND she also on NEXAVAR 200 mg BID. I would like to know it is safe to continue the medication. Also her WBC COUNTS always in between 2.3-2.9 so, if is SAFE to give her NUPOGEN shots weekly.
    Thank you so much for your time and help, I am so glad that you response us back. Again Thank You So Much For Your Help.

  20. Anonymous 02/22/2013 at 7:02 pm #

    Hello, a close family member had a MELD score of 14 a week ago two days after her first hospital visit from increased ammonia and encepholepathy. She has only experienced ascites for the first time once in the past month. Her ascites went away on Lasix. She has cirrhosis and hep c. The doctor did not offer the Interferon treatment even though according to academic journal research anyone MELD <24 is a candidate for low dose Interferon. Do you treat decompensated Interferon? How do we go about finding a doctor who does that? We are in the Pittsburgh are. Thanks so much for your time. This is a great resource.

    • Dr. Joe Galati 03/01/2013 at 6:24 am #

      Treating HCV in the setting of cirrhosis, complicated by ascites and hepatic encephalopathy is very risky. It is unlikely anyone would be willing to treat in a case like this. Newer drugs may soon be available, and less toxic in patients with decompensated cirrhosis.

  21. Rick 03/05/2013 at 7:51 am #

    Hello Dr.Galati

    I completed treatment 6months ago for Hep c, and last week a 6month follow up blood work only to find out that the virus is present again, i am totally discouraged at this point, are their any new treatments with less side affects in the pipeline? any suggestions??

  22. Shahida 04/01/2013 at 3:40 am #

    My husband is 69 years old and he is a physician in Georgia. He had a liver transplant at UAB in Feb 99. In 2008 he was diagnosed with Non Hodgkin Lymphoma and had surgery in Feb 2008 and presently, his cancer is in remission.My husband was working till Nov 2012, and he became very sick with his Bilirubin rising from 4 to 12.1 recently. His health has deteriorated rapidly.Since Nov 2012, we went to UAB thrice but the on call Hepatologist said it was chronic liver failure. My husband has become extremely weak, lost weight and is short of breath. His physician told him that his Meld score is 24 and suggested that we go to UAB to see if they can put him on the list for a second liver transplant. we went to our regular hepatolgist at UAB who has been my husband’s physician since his transplant.
    He explained the risks of a second transplant and admitted my husband who was sick and also his Bilirubin had had gone upto 12.1. The transplant team refused to put him on the list, stating his age and that he had lymphoma 4 years back and it would be too risky to do a transplant on him. I would like to know if he would be eligible for transplant at any other hospitals and is a second transplant too risky. Kindly respond.

  23. Cindy A. 04/13/2013 at 11:22 pm #

    Doctor,

    How will Obamacare affect organ transplants? Will Medicare patients qualify now? I’m sure the answer is complicated, could you direct me to a source of expertise for transplants summarized for the patient?

    I’ve been with the same transplant team since 2008 when they transplanted my sisters liver. I followed the team when they moved to a newly created transplant center at a major college hospital. The first hospital has a superior transplant center. Immediately after the move, my team started making major mistakes, they’ve improved somewhat.

    Bottom line: is it the team or the institute a patient should consider first? I’ve been afraid of getting a second opinion only to lose my seat on the bus. Is it wise to be a patient with 2 transplant centers? I have C, last stage cirrhosis, several encephalopathy episodes, several very low potassium readings, haven’t had ammonia over 108 and well controlled with Lactulose. Don’t know my MELD this month, last was 8 to 10.

    Thanks for taking time to answer these questions.

  24. Lisa Ortiz 05/01/2013 at 2:13 pm #

    My boyfriend is station overseas in Europe on a special project. Early this year he had taken very ill and was rushed to the ER due to bleeding and vomiting blood. He was later diagnosis with Alcoholic Hepatitis and had a case of ascites while hospitalized. Finally after several months his doctor finally referred him to the Liver Transplant Hospital. He was admitted to the Liver Transplant Hospital for evaluation to see if he qualifies for the transplant list. I’m a little wiry about the doctors over there. I don’t if their technology is modern or on the same level as the United States….His first MELD was 26….5 days later it dropped down to 22… No other medical problems listed. Do you think he has a better chance in Europe or you suggest for him to come back home to the states for proper treatment?? Can you please advise.

  25. Debbie botto 08/21/2013 at 11:24 pm #

    Hi Dr. Galati,

    My sister was diagnosed with Hep C and cirrhosis in 1999. She was treated 2 yrs and cleared of the virus. She contracted the Hep in 1978 after using heroin for 4 months. In 1982, she stopped drinking. She just celebrated 31 years of sobriety. Diagnosed with HCC jan ’11. Listed and chemoembolization done. MELD was around 11—> 22 with the HCC. 1 yr ago she got a positive urine screen of 0.06. My sister has been so very sick, falling down, encephalopathy, ascites–I know she didn’t drink but there is a no tolerance form that is signed. We think it was positive from something she gargled and swallowed for thrush treatment or mouthwash. She has been in a rehab since June and fighting recurring uti’s. Been drained twice with 2 hospitalizations and almost went into renal failure. She has lost hope that she will get a liver and asked asked for Hospice. I don’t want her to give up if she has a chance. California is difficult for transplant but we can’t move to another state. I guess I didn’t really ask a question ! If she cannot clear the uti’s, will she be passed over for a liver? Thank you, Debbie

  26. Lauren Houle 08/25/2013 at 8:11 pm #

    Hi Dr. Galati,
    My mother (62 years old) was diagnosed with Hepatitis C in the 90s and has been closely followed by a gastroenterologist since. She has been very compliant with her care. In 2011, her AFP went up and she started having serial CT scans. In October 2012 she was diagnosed with hepatocellular carcinoma. After having two TACE procedures, we had a transplant workup and I was approved to be her live donor. A week before surgery, a pre-op MRI showed the third tumor had grown. She received two additional TACE procedures. The most recent MRI in August showed a new 1.5 cm tumor (her fourth), making her ineligible for transplant, as the criteria states three tumors or less. She is having a radiofrequency ablation this week. Is there any chance we could have the transplant done in the future? We are anxious and unclear where we should be getting treatment. We have been getting her treatment at Lahey Clinic in Burlington, MA thus far. If she does not receive a transplant, what kind of prognosis does she have?
    Thank you.

    • Dr. Joe Galati 09/29/2013 at 8:03 am #

      Progressive cancer development in the face of therapy is a concern. Is she on Nexivar? Untreated, and no transplant, the prognosis in general is poor. Look and see if the transplant program considers extended criteria donors.

  27. kathy 08/29/2013 at 4:49 pm #

    My dad meld level is 15. I dont know how it works but i only have one question. How long can he live with the liver like this? He said he feels ill and his bones hurt and lost of appetite. I just want to know how long can he live? How many years? Months?

    • Dr. Joe Galati 09/29/2013 at 8:01 am #

      A MELD of 15 is low compared to others. There is a chance he can do well, but he should be evaluated for transplant, and monitored closely, for signs of deterioration, and liver cancer.

  28. Jack Carlisle 09/01/2013 at 1:30 am #

    Dear Dr.Galati,

    My wife is 43 years old and recently told that she has liver damage. Her MELD score is 28 and we are applying to be put on the transplant list. Our liver specialist says that her liver injury stems from the diet pill OxyElite Pro. Just a month ago she was in perfect health and now all of this is happening. Her eyes are very yellow and skin too. She gets very tired quickly and is showing signs of memory loss. Why do you think her condition is progressing at a very fast rate?

    • Dr. Joe Galati 09/29/2013 at 8:00 am #

      Very difficult to tell with the info you supplied. Certainly things are evolving fast. Alcohol, medicines, autoimmune disease, and other virus exposures can cause this rapid change.Is she at a transplant center?

  29. prince agarwal 09/06/2013 at 3:32 am #

    My mother aged 53 years has been suffering from hepatitis C.i have been to Apollo chennai.The doctors there said that her liver is so weak that her body cannot tolerate the medicine of hepatitis C.so he give medicine n said that we ll wait for 6 months along with some medicine to be continue…at first we ve to strong the liver.after that i went to delhi medanta ,apollo delhi,.they all said to immediatly liver transplant..what i shoud do..Doctor.there is totally confusing..matter.on 5/9/2013 i ve done the LIver Function test of my mother ..and calculate the MLD score.her score is 24.what shoud it indicate.Please hepl us out Doctor.:

    • Dr. Joe Galati 09/29/2013 at 7:58 am #

      MELD score of 24 is getting high. Yes, transplant evaluation seems appropriate. Can she come to Texas or other centers around the world?

  30. John Bruner 09/10/2013 at 4:42 pm #

    I have been treated for Hep C back in 2004 and had a severe reaction to the Interferon and Ribovarin. I have been under a Gastrointerologist’s and Liver Transplant Dr.s for the last 5 years. My MELD score is 12. I am 60 yrs. old and have been experiencing ascites (msp) and have had numerous varicies banded over the last 2 years. I have advanced Hep. C now and advanced Chirrosis of the liver. Will my age and Hep. C virus be a negative when being considered for a transplant? I am having a work-up done in October.

    • Dr. Joe Galati 09/29/2013 at 7:56 am #

      No, the HCV will not play a role right now. With the new HCV drugs soon to be released, treating HCV, as well as transplant patients will never be easier. Still all of this is a risk, but breakthrough’s are now taking place. The presence of ascites warrant a liver transplant evaluation now.

  31. Tammie Callahan 09/19/2013 at 2:54 am #

    My father is 70. He was on the transplant list for a liver at UTMB Galveston, due to Alpha 1 and NASH, until prostate cancer was found. It was treated successfully with radiation, finished May 2013, and his PSA is now undetectable. He has one more hormone shot to take as a preventative from what I understand. His MELD score is 24 as of 9-17-13. From what the nephrologist and liver team tells us his medical conditions could be resolved with a liver transplant. He does have a stent in his heart, but it was borderline and in preparation for the transplant we decided to go ahead and have it put in. My questions are:

    1) What is the waiting period for a transplant after cancer has been eradicated? UTMB does not do liver transplants at this time, so we have to find another facility. I understand that the anti rejection drugs could cause cancer cells to accelerate, but if he is willing to take the risk, can a transplant be performed?

    2) Is there an age that transplants cannot be performed, if the patient’s body appears strong enough to have the transplant?

    3) My father has stayed current on all his drs visits and tests, will these test results and information transfer to the new transplant facility or do we have to start all over again?

    Thank you for answer to these questions, we are at an impass and do not know where to go from here. My father is determined to beat this and he came through the cancer treatment without even suffering weakness, he was amazing as well as his cancer team. He is hoping for a transplant, so he can live a productive life once again, but time is of the essence. He has a great support team at home and we will do whatever it takes to help this transplant be successful!!!

    • Dr. Joe Galati 09/29/2013 at 7:54 am #

      With most cancers outside of the liver, there is a “5-year rule”, making sure patients are cancer-free, and will not develop cancer after the transplant. You are correct that the anti-rejection medicines weaken the immune system, and put patients at risk for cancer and infections.

      Each case is different. Age, type of cancer, stage, spread, and overall performance status of the patient is taken into account. We can certainly evaluate him at Houston Methodist if you would like. Contact our office at 713-794-0700 for details.

  32. Angela 10/02/2013 at 3:58 pm #

    Dear Dr. Galati:

    First I would like to say that I thank you in advance for such a nice service that you offer to the public with your blog. Thank you!

    I am a congressional consultant and work on legislation and help make laws. In 2009, I was diagnosed with cryptogenic cirrhosis but did have a biopsy that showed very slight fatty liver however the transplant centers do not feel that it was even remotely enough to cause the damage that my liver currently has however the portal vein thrombosis could be a huge factor as it cut off the blood flow to the liver.

    I am now in panic mode because I have never drank or smoked or lived any type of risky lifestyle and am of course negative on all Hepatitis tests however the doctors are telling me that my current health is not properly reflected in the MELD scoring and that I fall in a 5% category where those of us that are just as sick as others with high MELD scoring but because it is not reflected in the MELD scoring (mine is currently 7) I will never get to the top of the transplant list especially now that the influx of all those that will now be covered under the Affordable Health Care act (67% of which patients have a history of alcoholism and drug abuse) are now going to be moved onto the list and make me fall either to the very bottom or completely off and into a non-active status. This is not being talked about regarding the detrimental and deadly consequences of the ACA law. As a public figure and one that helps make laws I have of course read the full ACA law and this will be very damaging to many of us like me whose MELD scoring does not reflect how very sick we are. My ammonia levels are extremely high and I can no longer testify in court or before congress and I am now not working because of it not to mention that I have very severe malabsorption. Can you suggest what you feel that may be beneficial to patients in my position who are now going to be placed very far down the list as they place the influx of the new patients that will be covered under the ACA law (those that caused themselves harm) and we may now never make it to the top of the list before we die? Any suggestions would be helpful because I am going to see what I can do to stop us from being moved “behind” the new patients coming onto the list. I can work towards correcting this flaw but would need good suggestions on what would be the best angle. Feel free to contact me by email and I will most certainly work towards helping all of us who fall into this 5% category. I am now being told by my specialists to look outside of this country and that was just astonishing to hear but they are very good and understand the dilemma that I am now being placed in. I would be grateful for any suggestions.

    Cordially,
    Angela

    • Dr. Joe Galati 10/07/2013 at 8:41 pm #

      Thanks for the note.

      I see your point, but the influx of the patients you mention will take years to move the proverbial needle.

      Instead, you need to consider being dual listed at another US program, one that transplants at lower MELD scores, and consider having your transplant team write a MELD exception for you. This is a mechanism to gain additional points towards your own calculated MELD score. Looking outside the US is not advisable.

      Where are you currently listed?

  33. John Bruner 10/07/2013 at 11:49 am #

    Dr. Galati,

    I am being evaluated for a transplant this week at the Texas Liver Institute Methodist Hosp. in Dallas. My Transplant Dr. decided it would be a good idea since I have had bleeding varicies and ascites. My MELD score was 12, I don’t know what it is right now. I have had one small nose bleed occurance recently. I was born with an irregular heart beat and I have had less palpitations lately. I was started on Lasix along with doubling my spironolactone and it has made me feel much better. My concern is that I have low blood platelets (43) and I have been suffering from memory loss and the ability to think clearly sometimes. I have advanced Hep. C and advanced chirrosis of the liver. Do you think I am ready for a transplant at this level? Thank you for your opinion.

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