end stage cirrhosis of the liver

[tonychick]

Hello,

My aunt is 55 year old  married has an 11 year old daughter. She live in Grants, NM. Last year was diagnosed with cirrhosis of the liver.  They have done lots of test during this time. During the months of march and April is when she was referred to a liver specialist. She did biopsy and was determined she has stage 4 at the time MELD score at that time was 15. So in may wanted her to go to Denver  for the liver center . Her insurance which is a state funded plan denied her exam due to her bmi and at the time being stable enough. Before this her insurance does not cover for a gastric bypass which also was told that would help her lose weight. So as you can see she was stuck with nothing. When they denied her from Denver we contact the liver doctor who in turn directed her to her primary doctor.  Well she recently got sick because of the toxicin having hard time breathing. So she was admitted to hospital on July 18th 2013 She was so bad that they transferred to Albuquerque where they stabilized her and did as much as possible. Her meld score went up to 31. Denver said not a candidate. Do to BMI and how her health is she also has diabetes. She weighs about 265lbs she is 5’ 2 . At the time her kidneys were failing they were at 10%GFR which she was not urinating. After 3 days she did start finally urinating . which the kidneys started functioning. I don’t have the percent of the kidneys now. We were told Sunday that 66% she will not make it within the next three months and there is a 33% chance she will and that Denver is out of the question. Can you tell me is there anything that you could do? Would you consider doing a high risk transplant? Can you explain based what I have told you if she has no choice at this time? Based off what they said she decided to go home and live on hospice. But if there is a chance can you please advise. Thanks Please advise asap.

[HectorSF]

Hear are some of the top liver transplant centers in the country. They are more likely to take on difficult cases.

Cleveland Clinic
Liver Transplant Department Supervisor
Ph: 216.444.8770 or 800.223.2273 x48770

Ronald Reagan UCLA Medical Center; Los Angeles, CA
Adult Liver Transplant Program [phone]

NEW YORK-PRESBYTERIAN/WEILL CORNELL
CENTER FOR LIVER DISEASE AND TRANSPLANTATION
(646) 962-liver

UCSF Medical Center; San Francisco, CA
Phone: [phone]

St Luke's Episcopal Hospital
6720 Bertner Ave, Houston, TX 77030
Speak with a Liver Transplant Representative
877-685-0361

The Ochsner Multi-Organ Transplant Institute is located at:
1514 Jefferson Highway
New Orleans, LA 70121
Transplant Hotline [phone]

I hope this helps.
Hector

[tonychick]

Thank you for your information. I did try mayo clinic of AZ they said no becuase of BMI.

[HectorSF]

"Can you tell me is there anything that you could do? "

Is it University of Colorado Hospital that refused to list her?

Try other transplant centers. Transplant center have their now rules as to who they will transplant. She will have to go to the top transplant centers where they do more risky transplants. That would include UCSF here in San Francisco where we get patients from other centers that can't help them any more. Also I would try large transplant centers in New York City and LA where they do many transplants..

I would call them all and find out what their BMI and kidney disease requirements are for transplant. Of course she and her care givers would have to move to near the transplant center and probably stay there for a least 3 months post transplant.

Maybe Mayo clinic in Arizona will do it.

Would you consider doing a high risk transplant?
I personally would consider anything as hospice leads to only one thing.

Good luck.
Hector

[Advocate1955]

Unfortunately, due to the shortage of available organs, transplant centers are required to follow strict guidelines regarding the allocation of livers. A person must be under a specific BMI, and be otherwise healthy, in order to be considered for a transplant. She should find out the specific criteria and try, if she can, to meet them. The guidelines are fairly consistent from state to state, although some states transplant at lower MELDs than others.
The gastric surgery would probably be too risky for your aunt given the current state of her liver. It could cause her liver to fail.
Best wishes to your aunt. I hope she can lose weight to meet the BMI criteria and be evaluated to see if she can be listed.

[rivll]

http://www.ncbi.nlm.nih.gov/pubmed/18044787

Hi,
I am very sorry for what you and your aunt are going through. I cut and pasted the above link that explains a bit why they cannot accept your aunt for transplant at her current BMI. The mortality rate post transplant is very high.
It makes sense that those patients with a better chance at survival would be accepted for transplant.
I know Hector who is the expert will advise you so my response to you is mostly to bump your post up to the top to catch his eye.

In the meantime, she should still have her symptoms treated by a Liver specialist and she should meticulously follow the diet recommended by the Liver Specialist.
All the best.