Dr. Galati has been involved in liver transplantation since 1989.  He currently is the Medical Director of the Sherrie and Alan Conover Center for Liver Disease and Transplantation at Houston Methodist Hospital, in Houston, Texas. Dr. Galati and the liver transplant team at Houston Methodist Hospital is one of the most experienced teams in the world, and currently the second largest liver transplant program in the United States, and the largest in Texas.

Simply put, liver transplantation is the surgery that replaces a diseased liver with a healthy liver.  Currently in 2024, there are over 9,500 individuals waiting for a liver transplant. In 2023, approximately 10,600 liver transplants were performed in the United States.  The number of transplants performed in the United States has been slowly increasing for the past 20 years. In 2023, there we 948 liver transplants performed in Texas. Houston Methodist performed 249 liver transplants in 2023.

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 and fatty liver are the top diseases 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.

Dr. Joe Galati and the Houston Methodist Liver Transplant team have been approved by UNOS to perform live-donor liver transplants. While the selection process and criteria for this type of surgery is different that the more routine cadaver donor transplant surgery, asking about this as a possible option is welcomed.

Dr. Galati has posted several videos on liver transplantion on this website, which are listed below.

If you have additional questions on liver transplantation, please call our office, or request a consultation with Dr. Joe Galati.