by Dr. Joe Galati on 09/29/2013
by Dr. Joe Galati on 09/26/2013
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.
by Dr. Joe Galati on 07/21/2013
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.
by Dr. Joe Galati on 03/22/2013
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.
by Dr. Joe Galati on 02/02/2011
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.
- Telaprevir and FDA Approval: The Race is On for New Hepatitis C Drugs 02/28/2011
- The MELD Score and Liver Transplant: An Update for Patients 02/02/2011
- Waiting for a Liver Transplant: My MELD Score is Low-Now What? 06/14/2012
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About Dr. Galati
Dr. Joseph S. Galati is a native of Long Island, New York. He received his undergraduate degree at Syracuse University and attended St. George's University School of Medicine.
Following medical school, Dr. Galati was an Intern and Resident in Internal Medicine at State University of New York Health Science Center-Brooklyn (formerly Downstate Medical Center)/Kings County Hospital Center, one of the premier teaching hospitals in the country. He remained an additional year in the department to assume responsibilities as the Chief Medical Resident in the Department of Medicine under the direction of Dr. Donald E. Wilson, currently the Dean at the University of Maryland School of Medicine. Read more...