Dr. Galati has been involved in liver transplantation for the past 20 years. He currently is the Medical Director of the Center for Liver Disease and Transplantation at the Methodist Hospital in Houston, Texas.
Simply put, liver transplantation is the surgery that replaces a diseased liver with a healthy liver. In 2006, approximately 7,000 liver transplants were performed in the United States. The number of transplants performed in the United States has been slowly increasing for the past 15 years.
Liver transplantation needs to be considered in patients with advanced liver disease that are showing signs of life-threatening complications. These complications include bleeding from esophageal varices, hepatic encephalopathy, the development of ascites, the development of protein-calorie malnutrition, the development of significant bone loss, and the development of liver cancer. In the vast majority of cases, patients have well established cirrhosis leading to these complications. Currently, chronic hepatitis C is the number one disease leading to transplantation. Other diseases that can lead to cirrhosis and may warrant liver transplantation include chronic hepatitis B, alcoholic cirrhosis, primary sclerosing cholangitis, primary biliary cirrhosis, hereditary hemochromatosis, Wilson disease, liver cancer, and biliary atresia.
Once the patient is referred to our transplant center, they go through the liver transplant evaluation process. This is typically a two- to three-day outpatient evaluation where patients are seen by other members of the transplant team. These will include liver transplant surgeons, social workers, nutritionist and dietitians, specialized nurse coordinators that care for patients that received transplants, as well as other medical specialists including cardiologists, lung doctors or pulmonologists, psychiatrist if there is any past history of depression or other psychiatric disorders. In addition, patients undergo a number of laboratory tests and x-ray procedures. The evaluation, which is rather standardized, does have to be customized based on the patient, their underlying disease, and other medical problems.
Once the patient is evaluated and has met all of the other team members, their entire case is presented before our weekly medical review board where their case is discussed in detail. In most cases, patients are deemed suitable for transplantation. In various circumstances there may be other medical problems or complications that would prohibit patients from being listed for transplantation.
Once the patient is formally placed on the “list,” they are followed as an outpatient on a regular basis carefully monitoring their disease state. The priority for transplantation is based on their MELD score. This method allocates donor organs to the sickest patients first.
Once the patient is transplanted, their length of stay in the hospital will range from several days to several weeks based on how sick they were at the time of the transplant surgery. Patients will need to take medicines to prevent rejection of the transplanted liver. These immunosuppressants need to be taken the rest of their life. Skipping doses of the medication or not following the directions properly can lead to rejection, significant disease of the transplanted liver, and ultimately, failure of the liver, and premature death.