Itching and Hep C...AGAIN

[Michael-S]

Posted by Michael S on April 22, 1999 at 23:05:41
Hi....i received a liver transplant in August of 1998.  Unfortunately the Hep C came back real quickly and i need another transplant so ive been relisted.  It seems that once again, the "Itching" associated with my Hepatitis C Is actually driving me crazy.  I spoke with the doctors at Mount Sinai and ive tried Benadryl, ActiGall and another medicine (very odd effects so i discontinued this one immediately) and NOTHING HELPS!!! Occasionally "Sarna" cream helps, but it seems to be getting worst.  I heard of a thing called "photo Sensitivity" that might help.  What do you know about this and also what do you know about Hep C and Itching and ALSO THE MEDICINES TAKEN AFTER Tx and Itching.  Im told some of This itching (this time around) can be from some of the meds.  If you know of ANYTHING at all that may alleviate this at all, im willing to try anything!!  Thanks and W/B Soon!!       Michael

Posted by HFHSM.D.-D.M. on April 29, 1999 at 12:55:41

Dear Michael S:
I am not happy to hear about your situation.  Recurrent, cholestatic hepatitis C after liver transplantation is a major problem for transplant centers and for hepatitis C patients.   I assume that you are Mt. Sinai hospital in New York.  They are one of the very experienced centers with this problem.  I can appreciate how frustrated you and they must be.  
It sounds like you did not respond to actigall and benadryl.  You may have taken a drug called naltrexone that gave you the odd sensation.  This is a very effective drug for pruritus.  You will want to ask your physicians if this is the drug you tried.  If it is, you might want to try it at a lower dose.  We also use drugs such as phenobarbital and rifampin which can be very effective for itching.  These drugs can affect the level of your other immunosuppressive medications so they have to be monitored closely.  Cholestyramine is also a drug that can be effective.
On some occasions we actually treat the hepatitis C itself with interferon or interferon and ribavirin.  On some occasions we have seen excellent responses and in a few of these patients itching improved considerably.  On a few occasions I have taken patients with severe itching and put them on narcotics with some relief.  Clearly I would not do this unless there are no non-narcotic approaches that work.  
Phototherapy and plasmapheresis are treatments that have been used for itching in general and have been used for the itching of liver disease.  The general principle is that these modalities can remove substances in the blood that cause the itching.  I have not used either of these approaches with my patients and there is not a lot of information about using them in liver disease.  However, there are reports that in some cases they have been effective and I can’t immediately think of a reason they wouldn’t be safe.  Clearly your ultimate treatment will be the second transplant.  You could ask your physicians to consider phototherapy while you are waiting especially if nothing else works.  
Good luck with your situation and your second transplant. I hope this information is helpful to you. If you have any additional questions or concerns, you can post them through MEDHELP or contact us directly at Henry Ford.  We have an active liver transplant program. The direct number to our liver clinic is: [phone].
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.
Posted by Suzanne on May 12, 1999 at 01:09:40
I was surprised to see you mention cholestyramine for pruritis. I have HepC (20+ years) and had my gall bladder removed in January. Though my stools stopped being yellow, they remained soft and frequent. My GI recently prescribed cholestyramine to "bind bile salts" while my body is getting back to normal (!) after the operation, which he said could take 6 months.
Could you tell me about the connection between the abnormal gall bladder activity (I suddenly developed gallstones 3 months before the operation)and hepc? Is there a good chance I'll actually get back to normal, or are these soft stools a sign of hepc activity? Thanks.

Posted by HFHSM.D.-D.M. on May 23, 1999 at 17:58:19

Dear Suzanne:
One other MedHelp participant has asked me about the relationship between hepatitis C and gallstone.   I took the liberty of doing a computerized search to look into this.  
As for as I know there is no relationship between having a hepatitis C infection of the liver and having gallstones.  They really are two separate and distinct problems.  One of the drugs used for hepatitis C (ribavirin) has been reported to cause gallstones if used for along period of time, however, it is not clear to me that you are receiving treatment.  
I also don’t know of any relationship between hepatitis C and loose or soft stools.  Hopefully it is a problem that will resolve on its own.  Cholestyramine is a medication that sometimes causes constipation.
Good luck with you situation.   I hope this information is helpful to you. As always, you can post additional information through MEDHELP.  The direct number to our liver clinic is: [phone]. At Henry Ford, we have an active group of liver specialists with an interest in the care and research of hepatitis C.
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 pertaining to your health.