Liver transplant complicated by osteomyelitis(bone infection} in lower leg

[Hagart--Laird]

  I will die in time without a liver transplant.Does osteomyelitis in leg (open seepage,flare-ups treated with oral cipro}absolutely rule out a liver transplant while this condition exists?Amputation of the leg provides the most likely solution to the infectious beat up old leg but they tell me this is a risky operation due to the weak liver.
  Now the way I see it I can sit around and rot or take my chances soon before I deteriorate further.THE QUESTION IS which of the two operations should I try and go for ,assuming I will have a choice.
  If the transplant has a chance even with the low grade infection in the leg? Somehow I don't think I'll be given that chance, but if I was and it was successful, then the amputation would pose far fewer risks {the leg has to go ,it will also kill me, the cipro is losing its effectiveness against the infection.}Any thoughts? I think maybe I'll cross my fingers and go for the leg chop,50/50 isn't great odds but better to do something.
  Any ideas on all this.Hear of any specials on livers this month?best regards ,Laird Haggart

[HFHSM.D.-D.M.]

Dear Mr. Haggart
Well your question is certainly one of the most complex and difficult I’ve received.  I can only imagine how frustrating your dilemma must seem.
We are always careful to not give specific medical advice on MedHelp and your case is so complex, it would be impossible for me to tell you which of the two operations you should have first.  I would need to know far more information than I have and I would really need to examine you myself.  That being said, I am a transplant hepatologist and spend a great deal of my time deciding who is an acceptable candidate for liver transplant at Henry Ford and how these patients should best be managed.  I would like to make a couple of points.  
As a general rule, we are hesitant to do liver transplant in patients with on-going infections because the infection can seed the new liver and because the infection is only likely to worsen after transplant because we must use immuno-suppressive medicines to prevent rejection.  If it is felt that you are going to lose the leg regardless without amputation, then you might consider this.  It may be possible for the operation to be done with a spinal anesthetic which would lessen the likelihood of the liver failing after the operation.  It is possible your liver may worsen after the operation or that you may die but you seem to suggest this is likely to happen without the amputation.  I might hesitate to have the leg amputated just to become a liver transplant candidate, however, unless your transplant doctors feel you are a good candidate in all other regards.
I’ve not heard of any specials on livers this month though I do appreciate the question is made partially in jest.  However, I do like to point out that while some patients do die on the waiting list, the majority of patients in the US who need a liver, do get one.  
Good luck with your situation.   If I can be of any additional help or if you have more questions, please do not hesitate to contact me either through MEDHELP or directly at Henry Ford at [phone].  Henry Ford has a very active liver transplant program.  
This response is being provided for general informational purposes only and should not be considered medical advice or consultation.  Always check with your personal physician when you have a question physician when you have a question pertaining to your health.