Tag Archives: liver transplant

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.