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

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.

</p> <p><span class='st_facebook_buttons' st_title='Liver Transplant Houston: Calculating the MELD Score and How it Works' st_url='http://blog.texasliver.com/2013/03/liver-transplant-houston-calculating-the-meld-score-and-how-it-works/' displayText='share'></span><span class='st_twitter_buttons' st_title='Liver Transplant Houston: Calculating the MELD Score and How it Works' st_url='http://blog.texasliver.com/2013/03/liver-transplant-houston-calculating-the-meld-score-and-how-it-works/' displayText='share'></span><span class='st_email_buttons' st_title='Liver Transplant Houston: Calculating the MELD Score and How it Works' st_url='http://blog.texasliver.com/2013/03/liver-transplant-houston-calculating-the-meld-score-and-how-it-works/' displayText='share'></span><span class='st_sharethis_buttons' st_title='Liver Transplant Houston: Calculating the MELD Score and How it Works' st_url='http://blog.texasliver.com/2013/03/liver-transplant-houston-calculating-the-meld-score-and-how-it-works/' displayText='share'></span></p> </div> <div class="post-more"> <span class="comments"><a href="http://blog.texasliver.com/2013/03/liver-transplant-houston-calculating-the-meld-score-and-how-it-works/#respond" title="Comment on Liver Transplant Houston: Calculating the MELD Score and How it Works">Comments { 0 }</a></span> </div> </div>  <div class="post-637 post type-post status-publish format-standard hentry category-cirrhosis category-liver-transplant category-meld-score tag-cirrhosis-2 tag-liver-specialists-of-texas tag-liver-transplant-2 tag-meld-score-2"> <a href="http://blog.texasliver.com/2011/02/the-meld-score-and-liver-transplant-an-update-for-patients/" ><img src="http://blog.texasliver.com/wp-content/uploads/2011/02/web-olyx-pix-100x100.jpg" alt="The MELD Score and Liver Transplant: An Update for Patients" width="100" height="100" class="woo-image thumbnail alignleft" /></a> <h2 class="title"><a href="http://blog.texasliver.com/2011/02/the-meld-score-and-liver-transplant-an-update-for-patients/" rel="bookmark" title="The MELD Score and Liver Transplant: An Update for Patients">The MELD Score and Liver Transplant: An Update for Patients</a></h2> <p class="post-meta"> <span class="post-author"><span class="small">by</span> <a href="http://blog.texasliver.com/author/jgalati/" title="Posts by Dr. Joe Galati" rel="author">Dr. Joe Galati</a></span> <span class="post-date"><span class="small">on</span> 02/02/2011</span> </p> <div class="entry"> <div id="attachment_640" class="wp-caption alignleft" style="width: 160px"><a href="http://blog.texasliver.com/wp-content/uploads/2011/02/web-olyx-pix.jpg" ><img class="size-thumbnail wp-image-640" title="transplant" src="http://blog.texasliver.com/wp-content/uploads/2011/02/web-olyx-pix-150x150.jpg" alt="" width="150" height="150" /></a><p class="wp-caption-text">Liver Transplant</p></div> <p>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 <a href="http://www.methodisthealth.com/mtc.cfm?id=35448" onclick="javascript:_gaq.push(['_trackEvent','outbound-article','http://www.methodisthealth.com']);" target="_blank">Methodist Hospital</a>, are transplanting patients with MELD score is greater than 25.</p> <p>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.</p> <p>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.</p> <p>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 <a href="http://www.texasliver.com/" target="_blank">Liver Specialists of Texas</a> at 713-794-07 00.</p> <p><a href="http://www.mayoclinic.org/meld/mayomodel6.html" onclick="javascript:_gaq.push(['_trackEvent','outbound-article','http://www.mayoclinic.org']);" target="_blank">Calculate your MELD score</a> here</p> <p><span class='st_facebook_buttons' st_title='The MELD Score and Liver Transplant: An Update for Patients' st_url='http://blog.texasliver.com/2011/02/the-meld-score-and-liver-transplant-an-update-for-patients/' displayText='share'></span><span class='st_twitter_buttons' st_title='The MELD Score and Liver Transplant: An Update for Patients' st_url='http://blog.texasliver.com/2011/02/the-meld-score-and-liver-transplant-an-update-for-patients/' displayText='share'></span><span class='st_email_buttons' st_title='The MELD Score and Liver Transplant: An Update for Patients' st_url='http://blog.texasliver.com/2011/02/the-meld-score-and-liver-transplant-an-update-for-patients/' displayText='share'></span><span class='st_sharethis_buttons' st_title='The MELD Score and Liver Transplant: An Update for Patients' st_url='http://blog.texasliver.com/2011/02/the-meld-score-and-liver-transplant-an-update-for-patients/' displayText='share'></span></p> </div> <div class="post-more"> <span class="comments"><a href="http://blog.texasliver.com/2011/02/the-meld-score-and-liver-transplant-an-update-for-patients/#comments" title="Comment on The MELD Score and Liver Transplant: An Update for Patients">Comments { 34 }</a></span> </div> </div>  <div class="post-60 post type-post status-publish format-standard hentry category-liver-transplant tag-meld-score-2"> <a href="http://blog.texasliver.com/2008/03/meld-score-and/" ><img src="http://blog.texasliver.com/wp-content/uploads/2008/03/liver_blog.jpg" alt="MELD Score and the Question of When I am Getting My Liver?" width="100" height="65" class="woo-image thumbnail alignleft" /></a> <h2 class="title"><a href="http://blog.texasliver.com/2008/03/meld-score-and/" rel="bookmark" title="MELD Score and the Question of When I am Getting My Liver?">MELD Score and the Question of When I am Getting My Liver?</a></h2> <p class="post-meta"> <span class="post-author"><span class="small">by</span> <a href="http://blog.texasliver.com/author/jgalati/" title="Posts by Dr. Joe Galati" rel="author">Dr. Joe Galati</a></span> <span class="post-date"><span class="small">on</span> 03/17/2008</span> </p> <div class="entry"> <p><a href="http://texasliver.schipulwp.com/wp-content/uploads/2008/03/liver_blog.jpg" onclick="javascript:_gaq.push(['_trackEvent','outbound-article','http://texasliver.schipulwp.com']);"><img class="alignleft size-full wp-image-138" title="liver_blog" src="http://texasliver.schipulwp.com/wp-content/uploads/2008/03/liver_blog.jpg" alt="" width="100" height="65" /></a>Those of us involved in solid organ transplantation are faced with a question daily. That question is “when am I getting my liver?” The question is posed by patients, their family, or interested friends. In every case, I have to say, “I just don’t know, it depends on your MELD score”. And that’s the truth. Most patients have at best a primitive understanding of the MELD score. The longer they are on the list for transplant, the better they grasp the concept and how the system works. Below I will give an overview of how the MELD system works, and what this means to the individual patient.</p> <p>MELD stands for Model for End Stage Liver Disease, and was put into use in 2002. Before this time, patients needing liver transplants were grouped into four medical urgency categories. The categorieswere based on a scoring system that included some laboratory test results and some symptoms of liver disease. The symptoms of liver disease was difficult to control for and standardize. <span>One concern with using symptoms in scoring was that different doctors might interpret the severity of those symptoms in different ways. In addition, this scoring system could not easily identify which patients had more severe liver disease and were in greater need of a transplant. <span>Research showed that MELD accurately predict most liver patients’ short-term risk of death without a transplant. The MELD formulas are simple, objective and verifiable, and yield consistent results whenever the score is calculated.</span></span></p> <p>Calculating the MELD score can easily be done from numerous web sites. <a href="http://www.unos.org/resources/MeldPeldCalculator.asp?index=98" onclick="javascript:_gaq.push(['_trackEvent','outbound-article','http://www.unos.org']);">Click here</a> to calculate a MELD score. Scores can range from 6 (well) t0 40 (critical).</p> <p><span><span>The factors that go into calculating the MELD score include bilirubin, INR, and serum creatinine. Additional points are given if the patient has been receiving dialysis withing the past week. There is discussion that other factors may eventually be used to calculate the score, but for now this is the best we have. </span></span></p> <p><span><span>Bilirubin is elevated in chronic liver disease. Bilirubin is what gives the yellow skin color and jaundice seen in liver disease. The higher the bilirubin, the greater the jaundice. Bilirubin is an indirect marker of advanced liver disease. As a patient’s liver status becomes worse, and thus more sick, the bilirubin will tend to rise. The higher the bilirubin, the higher MELD score. You can plug in different bilirubin values to see how this well effect the score. The normal bilirubin is generally less than 1 mg/dL.</span></span></p> <p><span><span>The INR (<a href="http://www.labtestsonline.org/understanding/analytes/pt/test.html" onclick="javascript:_gaq.push(['_trackEvent','outbound-article','http://www.labtestsonline.org']);">International Normalized Ratio</a>) is a lab test frequently used in liver disease. With advancing liver disease, the vitamin K dependant clotting factors, which happen to be manufactured in the liver, are reduced. This will result in a prolonged INR. A prolonged INR increases the MELD score. </span></span></p> <p><span><span><a href="http://www.labtestsonline.org/understanding/analytes/creatinine/test.html" onclick="javascript:_gaq.push(['_trackEvent','outbound-article','http://www.labtestsonline.org']);">Creatinine</a> is a lab that measures kidney function. The kidney and liver are intimately related, in that as liver function declines, there is a high probability that kidney function will decline as well. Thus, an elevated creatine (worse kidney function) can be associated with advancing liver dysfunction and increased mortality and complication in the liver patient with advanced liver disease. Again, plug in different values for creatinine and you will see how the MELD will rise. A normal creatinine is usually less than 1 mg/dL.</span></span></p> <p><span><span>Waiting time for transplant does not generally play much of a role in organ allocation. Patients listed for transplant earlier, when they may not need transplant, would be given an unfair advantage. Time on the list could be a factor if two identical MELD score patients were offered an organ.</span></span></p> <p><span><span>The MELD score does not take into account various symptoms of chronic liver disease such as fatigue, depression, weakness, the presence of ascites, hepatic encephalopathy, or variceal bleeding. There are other symptoms that our patients report, not taken into strict accound in calculating the MELD score. Dealing with the symptoms, and the sense that they are getting more ill, is a very frustrating position for the patient, as well as the transplant team members. While we address and try to treat these symptoms, it is hard to accept their poor and declining quality of life does not come into consideration. Several medical conditions that had been considered in the prior liver allocation system, such as ascites and encephalopathy, are not included in the MELD system. This is because these factors have been tested in the MELD formula and did not add to the MELD score’s ability to predict death on the waiting list. In addition, the way these conditions are measured can vary from center to center; therefore, leaving them out of the MELD formula helps to make sure that all patients are scored the same way. </span></span></p> <p><span><span>On exception is to appeal to the regional review committee, made up of transplant physicians in a similar region where the patient is listed. This is an opportunity for the team to “ask for more points” to increase the chances that someone will be transplanted. </span></span></p> <p><span><span>How high your MELD score has to be before transplant varies on where you live. In the greater Houston area, a MELD of 22 and above (in general) will be a point where patients may be called for transplant. In California, a MELD score of over 30 will likely be needed for transplant. </span></span></p> <p><span><span>So what is the bottom line on the MELD score? Time on the list is of little value, and that this model aims to transplant those that are sickest first. Despite multiple symptoms that patients report, and how bad they feel, it has not been shown that these symptoms lead to an increased chance of death. It is true that you have to get more sick before getting transplanted, but the survival afterwards, and the regaining of quality of life, is what makes the system work. It is far from perfect, but it does work.</span></span></p> <p><span class='st_facebook_buttons' st_title='MELD Score and the Question of When I am Getting My Liver?' st_url='http://blog.texasliver.com/2008/03/meld-score-and/' displayText='share'></span><span class='st_twitter_buttons' st_title='MELD Score and the Question of When I am Getting My Liver?' st_url='http://blog.texasliver.com/2008/03/meld-score-and/' displayText='share'></span><span class='st_email_buttons' st_title='MELD Score and the Question of When I am Getting My Liver?' st_url='http://blog.texasliver.com/2008/03/meld-score-and/' displayText='share'></span><span class='st_sharethis_buttons' st_title='MELD Score and the Question of When I am Getting My Liver?' st_url='http://blog.texasliver.com/2008/03/meld-score-and/' displayText='share'></span></p> </div> <div class="post-more"> <span class="comments"><a href="http://blog.texasliver.com/2008/03/meld-score-and/#comments" title="Comment on MELD Score and the Question of When I am Getting My Liver?">Comments { 11 }</a></span> </div> </div> </div> <div id="sidebar"> <div id="tabs"> <ul class="wooTabs"> <li class="popular"><a href="#tab-pop">Popular</a></li> <li class="latest"><a href="#tab-latest">Latest</a></li> <li class="comments"><a href="#tab-comm">Comments</a></li> <li class="tags"><a href="#tab-tags">Tags</a></li> </ul> <div class="clear"></div> <div class="boxes box inside"> <ul id="tab-pop" class="list"> <li> <a href="http://blog.texasliver.com/2011/02/telaprevir-and-fda-approval-the-race-is-on-for-new-hepatitis-c-drugs/" ><img src="http://blog.texasliver.com/wp-content/uploads/2011/02/txliver-research-35x35.jpg" alt="Telaprevir and FDA Approval: The Race is On for New Hepatitis C Drugs" width="35" height="35" class="woo-image thumbnail" /></a> <a title="Telaprevir and FDA Approval: The Race is On for New Hepatitis C Drugs" href="http://blog.texasliver.com/2011/02/telaprevir-and-fda-approval-the-race-is-on-for-new-hepatitis-c-drugs/">Telaprevir and FDA Approval: The Race is On for New Hepatitis C Drugs</a> <span class="meta">02/28/2011</span> <div class="fix"></div> </li> <li> <a href="http://blog.texasliver.com/2011/02/the-meld-score-and-liver-transplant-an-update-for-patients/" ><img src="http://blog.texasliver.com/wp-content/uploads/2011/02/web-olyx-pix-35x35.jpg" alt="The MELD Score and Liver Transplant: An Update for Patients" width="35" height="35" class="woo-image thumbnail" /></a> <a title="The MELD Score and Liver Transplant: An Update for Patients" href="http://blog.texasliver.com/2011/02/the-meld-score-and-liver-transplant-an-update-for-patients/">The MELD Score and Liver Transplant: An Update for Patients</a> <span class="meta">02/02/2011</span> <div class="fix"></div> </li> <li> <a href="http://blog.texasliver.com/2008/03/meld-score-and/" ><img src="http://blog.texasliver.com/wp-content/uploads/2008/03/liver_blog-35x35.jpg" alt="MELD Score and the Question of When I am Getting My Liver?" width="35" height="35" class="woo-image thumbnail" /></a> <a title="MELD Score and the Question of When I am Getting My Liver?" href="http://blog.texasliver.com/2008/03/meld-score-and/">MELD Score and the Question of When I am Getting My Liver?</a> <span class="meta">03/17/2008</span> <div class="fix"></div> </li> </ul> <ul id="tab-latest" class="list"> <li> <a title="Heart Gift: Dr. Joe Galati Interviews Bret Sanders" href="http://blog.texasliver.com/2013/05/heart-gift-dr-joe-galati-interviews-bret-sanders/">Heart Gift: Dr. Joe Galati Interviews Bret Sanders</a> <span class="meta">05/19/2013</span> <div class="fix"></div> </li> <li> <a title="Dr. Joe Galati and the Liver Specialists of Texas Staff: Supporting Local Charities" href="http://blog.texasliver.com/2013/05/dr-joe-galati-and-the-liver-specialists-of-texas-staff-supporting-local-charities/">Dr. Joe Galati and the Liver Specialists of Texas Staff: Supporting Local Charities</a> <span class="meta">05/15/2013</span> <div class="fix"></div> </li> <li> <a title="Information on Colon Cancer: Colon Cancer Awareness Month with Dr. Joe Galati" href="http://blog.texasliver.com/2013/04/information-on-colon-cancer-colon-cancer-awareness-month-with-dr-joe-galati/">Information on Colon Cancer: Colon Cancer Awareness Month with Dr. Joe Galati</a> <span class="meta">04/07/2013</span> <div class="fix"></div> </li> </ul> <ul id="tab-comm" class="list"> <li> <img alt='' src='http://0.gravatar.com/avatar/209bc0176f59ab5f8d42cd9f539765e3?s=35&d=http%3A%2F%2F0.gravatar.com%2Favatar%2Fad516503a11cd5ca435acc9bb6523536%3Fs%3D35&r=G' class='avatar avatar-35 photo' height='35' width='35' /> <a href="http://blog.texasliver.com/2011/02/the-meld-score-and-liver-transplant-an-update-for-patients/#comment-86550" title="on The MELD Score and Liver Transplant: An Update for Patients"> Dr. Joe Galati: Treating HCV in the setting of cirrhosis, complica... </a> <div class="fix"></div> </li> <li> <img alt='' src='http://0.gravatar.com/avatar/44fc54a4ade786d8232953d2879b93d7?s=35&d=http%3A%2F%2F0.gravatar.com%2Favatar%2Fad516503a11cd5ca435acc9bb6523536%3Fs%3D35&r=G' class='avatar avatar-35 photo' height='35' width='35' /> <a href="http://blog.texasliver.com/2012/06/waiting-for-a-liver-transplant-my-meld-score-is-low-now-what/#comment-85668" title="on Waiting for a Liver Transplant: My MELD Score is Low-Now What?"> Ethan: My father has been stuck in limbo with a MELD hove... </a> <div class="fix"></div> </li> <li> <img alt='' src='http://1.gravatar.com/avatar/f10371f28f610383a587e4682e57b124?s=35&d=http%3A%2F%2F1.gravatar.com%2Favatar%2Fad516503a11cd5ca435acc9bb6523536%3Fs%3D35&r=G' class='avatar avatar-35 photo' height='35' width='35' /> <a href="http://blog.texasliver.com/2011/02/the-meld-score-and-liver-transplant-an-update-for-patients/#comment-85595" title="on The MELD Score and Liver Transplant: An Update for Patients"> Anonymous: Hello, a close family member had a MELD score of 1... </a> <div class="fix"></div> </li> </ul> <div id="tab-tags" class="list"> <a href='http://blog.texasliver.com/tag/fast-food/' class='tag-link-80' title='3 topics' style='font-size: 15.243243243243pt;'>"fast food"</a> <a href='http://blog.texasliver.com/tag/31-days-of-wellness/' class='tag-link-69' title='2 topics' style='font-size: 13.945945945946pt;'>31 Days of Wellness</a> <a href='http://blog.texasliver.com/tag/awareness/' class='tag-link-44' title='1 topic' style='font-size: 12pt;'>awareness</a> <a href='http://blog.texasliver.com/tag/beets/' class='tag-link-173' title='3 topics' style='font-size: 15.243243243243pt;'>Beets</a> <a 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href='http://blog.texasliver.com/tag/dietary-salt/' class='tag-link-29' title='3 topics' style='font-size: 15.243243243243pt;'>dietary salt</a> <a href='http://blog.texasliver.com/tag/diverticulitis/' class='tag-link-66' title='2 topics' style='font-size: 13.945945945946pt;'>diverticulitis</a> <a href='http://blog.texasliver.com/tag/diverticulosis/' class='tag-link-65' title='2 topics' style='font-size: 13.945945945946pt;'>diverticulosis</a> <a href='http://blog.texasliver.com/tag/edema/' class='tag-link-49' title='2 topics' style='font-size: 13.945945945946pt;'>EDEMA</a> <a href='http://blog.texasliver.com/tag/harry-smith-colonoscopy/' class='tag-link-36' title='1 topic' style='font-size: 12pt;'>harry smith colonoscopy</a> <a href='http://blog.texasliver.com/tag/heart-disease/' class='tag-link-31' title='1 topic' style='font-size: 12pt;'>heart disease</a> <a href='http://blog.texasliver.com/tag/hepatitis-b-2/' class='tag-link-154' title='2 topics' style='font-size: 13.945945945946pt;'>hepatitis B</a> <a href='http://blog.texasliver.com/tag/hepatitis-c-2/' class='tag-link-21' title='4 topics' style='font-size: 16.324324324324pt;'>hepatitis C</a> <a href='http://blog.texasliver.com/tag/hepatitis-c-treatment/' class='tag-link-9' title='3 topics' style='font-size: 15.243243243243pt;'>Hepatitis C treatment</a> <a href='http://blog.texasliver.com/tag/hypertension/' class='tag-link-33' title='1 topic' style='font-size: 12pt;'>hypertension</a> <a href='http://blog.texasliver.com/tag/interferon-2/' class='tag-link-22' title='1 topic' style='font-size: 12pt;'>interferon</a> <a href='http://blog.texasliver.com/tag/jack-lalanne/' class='tag-link-95' title='2 topics' style='font-size: 13.945945945946pt;'>Jack LaLanne</a> <a href='http://blog.texasliver.com/tag/liver-specialists-of-texas/' class='tag-link-11' title='10 topics' style='font-size: 20pt;'>Liver Specialists of Texas</a> <a href='http://blog.texasliver.com/tag/liver-transplant-2/' class='tag-link-108' title='3 topics' style='font-size: 15.243243243243pt;'>liver transplant</a> <a href='http://blog.texasliver.com/tag/meld-score-2/' class='tag-link-107' title='3 topics' style='font-size: 15.243243243243pt;'>meld score</a> <a href='http://blog.texasliver.com/tag/michelle-obama/' class='tag-link-52' title='2 topics' style='font-size: 13.945945945946pt;'>michelle obama</a> <a href='http://blog.texasliver.com/tag/new-hepatitis-therapy/' class='tag-link-24' title='1 topic' style='font-size: 12pt;'>new hepatitis therapy</a> <a href='http://blog.texasliver.com/tag/nutrition/' class='tag-link-72' title='8 topics' style='font-size: 19.027027027027pt;'>nutrition</a> <a href='http://blog.texasliver.com/tag/obesity/' class='tag-link-32' title='6 topics' style='font-size: 17.945945945946pt;'>obesity</a> <a href='http://blog.texasliver.com/tag/paleo-diet/' class='tag-link-157' title='3 topics' style='font-size: 15.243243243243pt;'>Paleo Diet</a> <a href='http://blog.texasliver.com/tag/polyps/' class='tag-link-42' title='1 topic' style='font-size: 12pt;'>polyps</a> <a href='http://blog.texasliver.com/tag/ribavirin/' class='tag-link-23' title='2 topics' style='font-size: 13.945945945946pt;'>ribavirin</a> <a href='http://blog.texasliver.com/tag/salad/' class='tag-link-142' title='4 topics' style='font-size: 16.324324324324pt;'>salad</a> <a href='http://blog.texasliver.com/tag/salt-2/' class='tag-link-46' title='3 topics' style='font-size: 15.243243243243pt;'>SALT</a> <a href='http://blog.texasliver.com/tag/side-effect-management/' class='tag-link-10' title='1 topic' style='font-size: 12pt;'>side effect management</a> <a href='http://blog.texasliver.com/tag/sodium/' class='tag-link-30' title='4 topics' style='font-size: 16.324324324324pt;'>sodium</a> <a href='http://blog.texasliver.com/tag/telaprevir/' class='tag-link-103' title='3 topics' style='font-size: 15.243243243243pt;'>telaprevir</a> <a href='http://blog.texasliver.com/tag/wellness/' class='tag-link-71' title='2 topics' style='font-size: 13.945945945946pt;'>wellness</a> </div> </div> </div> <div id="text-3" class="widget widget_text"><h3>About Dr. Galati</h3> <div class="textwidget"><p><img src="http://texasliver.schipulwp.com/wp-content/uploads/2010/12/6a00e54eea9caa883400e54fff22388833-250si.jpg" height="188" width="125" align="left" style="padding:2px;">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.</p> <p>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. <a href="http://blog.texasliver.com/about-dr-galati" >Read more...</a></p> </div> </div><div id="woo_flickr-2" class="widget widget_woo_flickr"><h3> Photos on <span>flick<span>r</span></span> </h3> <div class="wrap"> <div class="fix"></div> <script type="text/javascript" src="http://www.flickr.com/badge_code_v2.gne?count=6&display=latest&&layout=x&source=user&user=57089451@N08&size=s"></script> <div class="fix"></div> </div> </div><div id="fbw_likebox-3" class="widget widget_fbw_likebox"><h3>Like Liver Specialists of Texas on Facebook!</h3><iframe src='http://www.facebook.com/plugins/fan.php?id=61037341468&width=&connections=10&stream=false&header=false' scrolling='no' frameborder='0' allowTransparency='true' style='border:none; overflow:hidden; width:px; height:260px'>

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