Tag Archives: liver transplant
Nonalcoholic Fatty Liver Disease: What You Need to Know? Dr. Rashid Khan Explains

Nonalcoholic Fatty Liver Disease: What You Need to Know? Dr. Rashid Khan Explains

Dr. Rashid Khan, Hepatologist at Liver Specialists of Texas, guest edited this blog entry on Fatty Liver Disease.

Obesity and Fatty Liver Disease

Obesity and Fatty Liver

In my 9 years of medical practice, it still does not cease to amaze me, that the public as well as the general physician’s perspective on fatty liver disease could be so wrong.

Every day of the week I see at least 10 patients with fatty liver, who have been told by their family physician that fatty liver is “no big deal”, and it is nothing to worry about. I tell them it is “ absolutely something to worry about”. Let me explain why.

Nonalcoholic fatty liver disease is a condition where there is fat accumulation in the liver of people who drink little or no alcohol.This condition is very common and generally causes no signs or symptoms, and generally no complications. Most people feel “OK” with this condition.

A wide range of diseases and conditions can increase your risk of nonalcoholic fatty liver disease, including: gastric bypass surgery, high cholesterol, high levels of triglycerides in the blood, metabolic syndrome, polycystic ovary syndrome, sleep apnea, diabetes, hypothyroidism, and of course, obesity.

In some people with fatty liver, the fat that accumulates can cause inflammation and scarring in the liver. This form of nonalcoholic fatty liver disease is called nonalcoholic steatohepatitis, commonly called NASH. In its most severe form, fatty liver can progress to liver cirrhosis (scarring), liver failure, and even liver cancer. About 20% of patients with fatty liver disease related steatohepatitis can progress to liver cirrhosis, so the risk is not trivial. In these such cases, liver transplant is discussed, and may be the only option to survive.

Evaluation of fatty liver begins with simple blood tests to assess liver function. These blood tests are the ALT, AST, bilirubin, and possibly alkaline phosphatase.

Unfortunately, many times these liver tests are elevated, and ignored by both physician and patient. These elevated (and abnormal) liver tests may be the first indication that trouble is brewing in the liver. This is almost always followed by some sort of liver imaging test, such as an ultrasound, CT scan or MRI of the liver and abdomen. If I suspect a more advanced stage of fatty liver disease, I will recommend we perform a liver biopsy, a procedure that involves removing a small sample of tissue from the liver, and examining it under a microscope to look for signs of inflammation and scarring.

Unfortunately, despite extensive research in this field, no single standard and targeted therapy exists for fatty liver disease in 2015. In other words , no medication is currently the perfectly effective treatment for fatty liver disease. Almost always my patient will ask me , “Hey Doc, what pill can I take to fix this problem? And I reply there is none.

So we typically work to reduce the risk factors that have caused the fatty liver disease which are well known as I have eluded to above. If the patient is obese, we ask them to lose weight. Weight loss can be tough in the modern day lifestyle, but a committed approach involving caloric reduction and increasing physical activity usually works. Patients with diabetes and or high cholesterol are placed on medications to better control these disorders of their metabolism.

No alternative medicine treatments are proven to cure nonalcoholic fatty liver disease. The use of herbs, and many other widely available over the counter supplements not only don’t work, but can be dangerous. Some studies have shown that natural substances such as Vitamin E and coffee may help to reduce the damage caused by inflammation. However, more research is needed, and patients should discuss the use of these substances with their liver specialist.

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Liver Transplant with Donors Over 80 Years Old Do Well

Liver Transplant with Donors Over 80 Years Old Do Well

A research paper presented this morning at the AASLD Liver Meeting indicates that liver donors 80 years of age and older do just as well as those receiving a liver transplant from a donor less than 80 years old.

Considering the large number of patients awaiting liver transplant, and the associated limited number of suitable donors, resulting in unacceptable wait-list deaths, serious consideration should be given to accepting older donors, especially those over 80 years old.


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Alcoholic Liver Disease: What You Need to Know-The Basics

Our latest video covers the basic aspects of alcohol related liver disease, and the complications of excessive alcohol intake. In general, there are three areas of concern:

1. The development of alcoholic fatty liver disease

2. The development of acute alcoholic hepatitis

3. Alcoholic cirrhosis

The major point to understanding is that all alcoholic drinks (servings) have about the same amount of alcohol in them. Thus, 1-beer, 1-glass of wine, and 1-serving of spirit (i.e. vodka, rum, gin, etc) all have approximately 10-12 grams of alcohol in them. Alcohol is alcohol, regardless of the volume, color, or taste.

The other key point to remember, is that the amount of alcohol daily is different for men and women. For women, one serving/day is the limit; two for men. Period. Above this, you run the risk of complications.

View our latest video.

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Should Alcoholics Be Allowed to Receive Liver Transplants?

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Alcohol, Liver, Cirrhosis and Transplant: Dr. Galati Discusses

A segment that I recorded for this weeks Your Health First was with Dr. Howard Monsour. who’s the Chief of hepatology at Houston Methodist. In this two-part interview, we discussed various aspects of alcoholic liver disease, effects of acetaminophen on the liver, and the difference between men and women in their alcohol consumption.

As noted in prior posts, the issue of liver transplant in patients with alcoholism and alcoholic cirrhosis is controversial, but when carefully reviewed, their outcomes following transplant are equal or better than other diseases we transplant livers for.

Watch the video interview here.

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Wilsons Disease Houston:Transplant Will Cure the Disease

While still on vacation this week, I received news from my murse that one of our patients who has Wilsons Disease received his liver transplant. It was quite a relief for the patient, his family, and all of us taking care of him that his transplant took place.

In this particular case, the neurologic effects of the Wilsons Disease where the predominant features. While he did have cirrhosis, and the associated problems related to portal hypertension, the neuro-cognative symptoms predominated. This resulted in a wide range of symptoms, ranging from depression, apathy, mood swings, and difficulty in completing complex tasks.

This is typical for copper overload, making the diagnosis and treatment difficult. In up to 15% of the cases, the neurological effects get worse once therapy is started.

Across America, the allocation of donor organs is based on the MELD score -discussed previously. Many time, those with Wilsons Disease have low scores, making timely transplants problematic. On rare occasions, MELD exceptions can be allowed, but in most cases, the wait can be long and frustrating for all.

My hope is that our latest transplant does well. It will take several months for his copper metabolism to correct, and his disease has now been cured with the transplant and the new liver.

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Liver Transplant Houston: Calculating the MELD Score and How it Works

For those patients awaiting a liver transplant, the MELD score, which is a number calculated by evaluating the bilirubin, creatinine, and INR, is what the allocation of donor livers is based on. The higher the MELD score, the more likely you will get a liver transplant. At the same time, the higher the MELD score, the greater chance of life threatening complications. The majority of deaths that occur on the liver transplant waiting list take place in those patients with the highest MELD scores.

This video outlines some of the features of the MELD score calculation, and the potential for “MELD Exception” points to be added to the calculated MELD score.

I look forward to receiving your feedback.