Aa
LIVER TRANSPLANT
I HAVE BEEN INFORMED THAT I WILL NEE A LIVER TRANSPLANT. I AM IGNORANT TO MANY ASPECTS OF THIS PROCEEURE. IT IS BECAUSE OF THIS FORUM QUESTIONS HAVE BEEN BROUGHT TO LIGHT. MY PHY. HAS NOT DISCUSSED MANY OF THE ASPECTS OF MY HEPC AN LIVER DAMAGE. I HAVE A MEETIG WITH HIM AND HIS STAFFINORER TO RECIEVE A 2ND OPINION I HAVE TO HAVE HIM WRITE AN ORDER.THIS SEEMS LIKE A CONFLICT OF INTEREST. BECAUSE OF COMPLICATIONS I HAVE STOPPED RIBO AN PEG. IF I RECIEVE A TRANSPLANT WITH HPC PRESENT I WIIL RETAIN THE DISEASE AND INFECT THE NEWW LIVER,ONLY TO EXSTEND MY SITUATION.WHAT IS YOUR THOUGHTS ON THESE MATTERS.
Here is some more information that you may find interesting.
1) Explanted liver inflammatory grade predicts fibrosis progression in hepatitis C recurrence.
Liver Transpl. 2011
"...Explant grade >4 was associated with increased HCV-related graft loss at 1 (6% versus 3%) and 5 (36% versus 14%) years post-LT (P = 0.003). On univariate and multivariate Cox regression analysis, predictors of advanced fibrosis were explant grade >4 (hazard ratio [HR] = 3.3, 95% confidence interval [CI] = 1.9-5.6, P 50 (HR = 3.3, 95% CI = 1.9-5.7, P 158,730 IU/mL (HR = 1.8, 95% CI = 1.05-3.1, P = 0.03).
CONCLUSION: Explant histologic grade can identify patients requiring more aggressive monitoring and intervention for HCV recurrence post-LT.
See: http://reference.medscape.com/medline/abstract/21618689?src=nlbest
2) Hepatitis C virus-infected women have a higher risk of advanced fibrosis and graft loss after liver transplantation than men.
"Conclusion: Female sex represents an underrecognized risk factor for advanced recurrent HCV disease and graft loss. Further studies are needed to determine whether modification of donor factors, immunosuppression, and posttransplantation therapeutics can equalize HCV-specific outcomes in women and men. (HEPATOLOGY 2011;)."
See: http://www.ncbi.nlm.nih.gov/pubmed/21538434
3) The impact of donor race on recurrent hepatitis C after liver transplantation
"CONCLUSION:
Patients receiving white donor grafts had significantly worse recurrent HCV than those receiving grafts from African American donors regardless of recipient race. This difference was especially marked in African American recipients and persisted on multivariate analysis. These data suggest a graft from a white donor is potentially one more important variable in identifying patients at risk for more aggressive recurrent HCV after orthotopic liver transplant."
See: http://www.ncbi.nlm.nih.gov/pubmed/21168656
Be well,
Mike
1) Explanted liver inflammatory grade predicts fibrosis progression in hepatitis C recurrence.
Liver Transpl. 2011
"...Explant grade >4 was associated with increased HCV-related graft loss at 1 (6% versus 3%) and 5 (36% versus 14%) years post-LT (P = 0.003). On univariate and multivariate Cox regression analysis, predictors of advanced fibrosis were explant grade >4 (hazard ratio [HR] = 3.3, 95% confidence interval [CI] = 1.9-5.6, P 50 (HR = 3.3, 95% CI = 1.9-5.7, P 158,730 IU/mL (HR = 1.8, 95% CI = 1.05-3.1, P = 0.03).
CONCLUSION: Explant histologic grade can identify patients requiring more aggressive monitoring and intervention for HCV recurrence post-LT.
See: http://reference.medscape.com/medline/abstract/21618689?src=nlbest
2) Hepatitis C virus-infected women have a higher risk of advanced fibrosis and graft loss after liver transplantation than men.
"Conclusion: Female sex represents an underrecognized risk factor for advanced recurrent HCV disease and graft loss. Further studies are needed to determine whether modification of donor factors, immunosuppression, and posttransplantation therapeutics can equalize HCV-specific outcomes in women and men. (HEPATOLOGY 2011;)."
See: http://www.ncbi.nlm.nih.gov/pubmed/21538434
3) The impact of donor race on recurrent hepatitis C after liver transplantation
"CONCLUSION:
Patients receiving white donor grafts had significantly worse recurrent HCV than those receiving grafts from African American donors regardless of recipient race. This difference was especially marked in African American recipients and persisted on multivariate analysis. These data suggest a graft from a white donor is potentially one more important variable in identifying patients at risk for more aggressive recurrent HCV after orthotopic liver transplant."
See: http://www.ncbi.nlm.nih.gov/pubmed/21168656
Be well,
Mike
Thanks Mike, you are 100% correct. I have seen the 10%-30% (10%-25% AASLD) figures for liver failure or cirrhosis within 5 years of transplant in recent papers.
Thanks for the correction! And I am the first to jump on others who post misleading "facts".
;-) Ooops!
Yes, when the only option is a liver transplant, I agree we need to encourage others to get listed and transplanted. (Hopefully people will be successfully treated first). Transplants save lives and gives us a new lease on life that we wouldn't normally have.
...Two others things I had read that maybe you have heard of are; a younger donor liver increases time to recurrence of HCV and that the C/C allele increases chances of HCV treatment success and a longer time to recurrence of HCV.
-------------------------------------------------------------------------------------------------------------------------
Management of Hepatitis C Virus Infection in the Setting of Liver Transplantation
Hector Rodriguez-Luna and Hugo E. Vargas
http://www.aasld.org/conferences/Documents/CAQ%20Corner%20Documents/RodriguezLune.pdf
Donor Factors
The most consistent donor factor associated with fibrosis progression seems to be the use of older donors. Despite efforts to define donor factors that may influence the course of recurrent HCV, only older age has enough evidence to substantiate the claims made by the task force as a significant factor in viral recurrence. 26,58
Interestingly, donor infection with HCV has not been linked to poor outcome. 59
HLA matching appears to have little effect on the outcome of HCV recurrence.
Donor fat content has also been identified as a potential factor. 60
26. Berenguer M, Prieto M, San Juan F, Rayon JM, Martinez F, Carrasco D, et al. Contribution of donor age to the recent decrease in patient survival among HCV-infected liver transplant recipients. Hepatology 2002;36:202-210.
58. Wali M, Harrison RF, Gow PJ, Mutimer D. Advancing donor liver age and rapid fibrosis progression following transplantation for hepatitis C. Gut 2002;51:248-252.
59. Vargas HE, Laskus T, Wang LF, Lee R, Radkowski M, Dodson F, et al. Outcome of liver transplantation in hepatitis C virusinfected patients who received hepatitis C virus-infected grafts. Gastroenterology 1999;117:149-153.
60. Vargas HE, Laskus T, Wang LF, Radkowski M, Poutous A, Lee R, et al. The influence of hepatitis C virus genotypes on the outcome of liver transplantation. Liver Transpl Surg 1998;4: 22-27.
---------------------------------------------------------------------------------------------------------------------------
61st Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2010)
October 29 - November 2, 2010, Boston, MA
"IL28B Gene Patterns and Liver Transplant Outcomes in Hepatitis C Patients"
Michael Charlton and colleagues looked at the prevalence and impact on clinical outcomes of donor and recipient IL28B gene patterns among 189 hepatitis C patients who underwent liver transplantation between 1995 and 2005 at the Mayo Clinic in Rochester; 65 of them received interferon-based therapy.
Results
* The rs12979860 C/C pattern was less common among liver recipients (33%) than it was in donor livers (47%), meaning some patients with a less favorable gene pattern got a new liver with a more favorable pattern.
* Recipients with the protective C/C pattern had a longer time before post-transplant HCV recurrence.
* The C/C pattern in either the recipient or the donor liver was independently associated with greater likelihood of sustained treatment response:
- Both recipient and donor with C/C: SVR 86%;
- Donor but not recipient with C/C: SVR 50%;
- Recipient but not donor with C/C: SVR 42%;
- Neither recipient nor donor with C/C: SVR 16%.
*** IL28B gene pattern was not, however, significantly associated with overall survival or risk of liver-related death.
"Recipient IL28B genotype is associated with more rapid histological recurrence of HCV," the researchers concluded. "Recipient and donor liver IL28B genotype are strongly and independently associated with interferon-based treatment response in patients post-[transplant]."
"The data suggest that C/C donor livers might be preferentially allocated to patients with HCV infection," they recommended.
Cheers!
Hector
Thanks for the correction! And I am the first to jump on others who post misleading "facts".
;-) Ooops!
Yes, when the only option is a liver transplant, I agree we need to encourage others to get listed and transplanted. (Hopefully people will be successfully treated first). Transplants save lives and gives us a new lease on life that we wouldn't normally have.
...Two others things I had read that maybe you have heard of are; a younger donor liver increases time to recurrence of HCV and that the C/C allele increases chances of HCV treatment success and a longer time to recurrence of HCV.
-------------------------------------------------------------------------------------------------------------------------
Management of Hepatitis C Virus Infection in the Setting of Liver Transplantation
Hector Rodriguez-Luna and Hugo E. Vargas
http://www.aasld.org/conferences/Documents/CAQ%20Corner%20Documents/RodriguezLune.pdf
Donor Factors
The most consistent donor factor associated with fibrosis progression seems to be the use of older donors. Despite efforts to define donor factors that may influence the course of recurrent HCV, only older age has enough evidence to substantiate the claims made by the task force as a significant factor in viral recurrence. 26,58
Interestingly, donor infection with HCV has not been linked to poor outcome. 59
HLA matching appears to have little effect on the outcome of HCV recurrence.
Donor fat content has also been identified as a potential factor. 60
26. Berenguer M, Prieto M, San Juan F, Rayon JM, Martinez F, Carrasco D, et al. Contribution of donor age to the recent decrease in patient survival among HCV-infected liver transplant recipients. Hepatology 2002;36:202-210.
58. Wali M, Harrison RF, Gow PJ, Mutimer D. Advancing donor liver age and rapid fibrosis progression following transplantation for hepatitis C. Gut 2002;51:248-252.
59. Vargas HE, Laskus T, Wang LF, Lee R, Radkowski M, Dodson F, et al. Outcome of liver transplantation in hepatitis C virusinfected patients who received hepatitis C virus-infected grafts. Gastroenterology 1999;117:149-153.
60. Vargas HE, Laskus T, Wang LF, Radkowski M, Poutous A, Lee R, et al. The influence of hepatitis C virus genotypes on the outcome of liver transplantation. Liver Transpl Surg 1998;4: 22-27.
---------------------------------------------------------------------------------------------------------------------------
61st Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2010)
October 29 - November 2, 2010, Boston, MA
"IL28B Gene Patterns and Liver Transplant Outcomes in Hepatitis C Patients"
Michael Charlton and colleagues looked at the prevalence and impact on clinical outcomes of donor and recipient IL28B gene patterns among 189 hepatitis C patients who underwent liver transplantation between 1995 and 2005 at the Mayo Clinic in Rochester; 65 of them received interferon-based therapy.
Results
* The rs12979860 C/C pattern was less common among liver recipients (33%) than it was in donor livers (47%), meaning some patients with a less favorable gene pattern got a new liver with a more favorable pattern.
* Recipients with the protective C/C pattern had a longer time before post-transplant HCV recurrence.
* The C/C pattern in either the recipient or the donor liver was independently associated with greater likelihood of sustained treatment response:
- Both recipient and donor with C/C: SVR 86%;
- Donor but not recipient with C/C: SVR 50%;
- Recipient but not donor with C/C: SVR 42%;
- Neither recipient nor donor with C/C: SVR 16%.
*** IL28B gene pattern was not, however, significantly associated with overall survival or risk of liver-related death.
"Recipient IL28B genotype is associated with more rapid histological recurrence of HCV," the researchers concluded. "Recipient and donor liver IL28B genotype are strongly and independently associated with interferon-based treatment response in patients post-[transplant]."
"The data suggest that C/C donor livers might be preferentially allocated to patients with HCV infection," they recommended.
Cheers!
Hector
You got excellent advice from Mike and Hector please pay attention to what they have to say as they are extremely knowledgable and not just guessing at anything as others on the forum are prone sometimes to do.
I believe you may have overstated the case just a bit here.
You said : "...If the virus is not eliminated pre-transplant then it will need to be treated after transplant or it will destroy the donor liver (cirrhosis) usually with 5-10 years....."
I have seen numbers that suggest that between 20% and 30% of HCV transplant recipients who don't treat successfully will become cirrhotic within 5 years. Those are not great odds 20% - 30% - but it's a brighter picture than you painted.
I point this out because, as you know, there is plenty of anxiety surrounding liver transplantation and I'd hate someone to be overly worried.
Mike
You said : "...If the virus is not eliminated pre-transplant then it will need to be treated after transplant or it will destroy the donor liver (cirrhosis) usually with 5-10 years....."
I have seen numbers that suggest that between 20% and 30% of HCV transplant recipients who don't treat successfully will become cirrhotic within 5 years. Those are not great odds 20% - 30% - but it's a brighter picture than you painted.
I point this out because, as you know, there is plenty of anxiety surrounding liver transplantation and I'd hate someone to be overly worried.
Mike
Please turnoff the caps lock on your keyboard. It makes it difficult to read your post and all capital letters mean you are shouting. No need to shout...
What type of doctor says that you need a liver transplant? General Practioner (GP)? Gastroenterologist? Hepatologist?
Yes, your doctor has your records so he has to be involved in sending copies to the doctor that you are getting a 2nd opinion from. This is not a conflict of interest. You are free to go to any doctor you choose assuming your health insurance will pay for it. Assuming your current doctor is correct and you will need a liver transplant you should find a hepatologist at a liver transplant center to evaluate the status of your liver disease. The sooner you make contact with the transplant center the better.
It is unclear why you stopped treatment. Was this treatment the last attempt to cure your hepatitis C before your advanced liver disease made it impossible to treat due to the risk of further damaging your liver?
Yes if you have HCV still active in your body your new liver will become infected by the virus. Sometimes patients can be treated close to the time off transplant have their viral loads reduced to undetected and the donor liver won't be infected. It all depends on your individual circumstances. If the virus is not eliminated pre-transplant then it will need to be treated after transplant or it will destroy the donor liver (cirrhosis) usually with 5-10 years.
Most liver transplants are performed on patients who have hepatitis C which has caused their livers to fail. So hepatitis C and liver transplants is a common diagnoses that hepatologists at transplant centers deal with on a daily basis.
Hector
What type of doctor says that you need a liver transplant? General Practioner (GP)? Gastroenterologist? Hepatologist?
Yes, your doctor has your records so he has to be involved in sending copies to the doctor that you are getting a 2nd opinion from. This is not a conflict of interest. You are free to go to any doctor you choose assuming your health insurance will pay for it. Assuming your current doctor is correct and you will need a liver transplant you should find a hepatologist at a liver transplant center to evaluate the status of your liver disease. The sooner you make contact with the transplant center the better.
It is unclear why you stopped treatment. Was this treatment the last attempt to cure your hepatitis C before your advanced liver disease made it impossible to treat due to the risk of further damaging your liver?
Yes if you have HCV still active in your body your new liver will become infected by the virus. Sometimes patients can be treated close to the time off transplant have their viral loads reduced to undetected and the donor liver won't be infected. It all depends on your individual circumstances. If the virus is not eliminated pre-transplant then it will need to be treated after transplant or it will destroy the donor liver (cirrhosis) usually with 5-10 years.
Most liver transplants are performed on patients who have hepatitis C which has caused their livers to fail. So hepatitis C and liver transplants is a common diagnoses that hepatologists at transplant centers deal with on a daily basis.
Hector
P.S.....seeing that this article says there's 'no way to make the Hep C virus go away', it must be an older article. Ask your doc about the new drugs, with a new liver. I can only imagine how overwhelming this might be for you. We have good people here, who can put that anxiety at ease. The most important thing it to get you healthy.
Hi there. This is a very good question. I just looked over a few articles and this one seems to be the consensus:
WILL A LIVER TRANSPLANT CURE HEP C?
No. Hepatitis C and B viruses can live in cells other than in the liver. Once the old liver is removed and the new one is connected the hepatitis virus spreads back into the liver within the first weeks to months after the transplant. It is almost certain to occur with Hepatitis C. This is the bad news: at present we have no way to make the hepatitis C virus go away completely. The good news is that overall results with hepatitis C after liver transplantation is good because although the disease comes back it does not seem to greatly damage the liver in the majority of cases. Occasionally, it is possible for the hepatitis to return so severely that the new liver fails very soon, but this is uncommon.
Also, as for a second opinion.....I have had other pending procedures and my doctor has given me the name of another doctor for a second opinion, so it may be common place. By giving you the referral, it may get you in quicker, where as if you tried on your own, you might have to wait longer. But if you are uncomfortable and want to do it behind his back, that's fine too. Pick another doc and see what they recommend. Praying all the best for you and hoping your doctors will provide the clarity you need to make a decision.
WILL A LIVER TRANSPLANT CURE HEP C?
No. Hepatitis C and B viruses can live in cells other than in the liver. Once the old liver is removed and the new one is connected the hepatitis virus spreads back into the liver within the first weeks to months after the transplant. It is almost certain to occur with Hepatitis C. This is the bad news: at present we have no way to make the hepatitis C virus go away completely. The good news is that overall results with hepatitis C after liver transplantation is good because although the disease comes back it does not seem to greatly damage the liver in the majority of cases. Occasionally, it is possible for the hepatitis to return so severely that the new liver fails very soon, but this is uncommon.
Also, as for a second opinion.....I have had other pending procedures and my doctor has given me the name of another doctor for a second opinion, so it may be common place. By giving you the referral, it may get you in quicker, where as if you tried on your own, you might have to wait longer. But if you are uncomfortable and want to do it behind his back, that's fine too. Pick another doc and see what they recommend. Praying all the best for you and hoping your doctors will provide the clarity you need to make a decision.
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