LIver and transplanted kidney

Had my first kidney transplant in 1988 and got HepC from that. Never any complications(liver function and enzyemes perfect) from the Hep until now. 2nd transplant in Feb02. Five weeks ago, my ast, alt's start going up and now, they are at AST 231,Alt 361. Just had a ultrasound and the liver looked good, got my 1st viral load back and its just over 500,000. Retaining fluid and kidney function has went down. Baseline on my kidney is 1.9 on creatinine. Creatinine has gone to 2.8 Just got out of the hospital and got the fluid off with lasix. Doctors don't know if its the kidney or liver, G.I. says its the kidney, Nephrologist says its the liver. Prograf level(anti-rejection meds) have been eratic in blood work. Don't think the G.I. around here has alot of experience with HepC. Going for a kidney biopsy this Friday, never had a liver biop. I know this is a different situation from you guys, but like to know what to do and maybe the G.I.P.A could comment what she thinks is more likely. Kidney or Liver?

[lackalustre]

you may ask the dr about doing a liver biopsy the same time as the kidney biopsy while you are sedated.
    since you have high enzymes and a viral load count it may pay to see what shape you liver is in to help determine what to do.  just my two cents worth.  you have been thru a lot.  prayers and hope the very best for u.....

[garyford]

Forgot to add, I'm a 37 year old male. I was thinking about the double biopsy myself, but didn't know about the complications, figured they would want to do one at a time. I'll ask though, thanks for any input.

[lackalustre]

another word since you are a kidney tp.   if you should ever decide to do treatment for hepc   pegasys would seem a better drug of choice than pegintron.  pegasys is metabolized by the liver rather than kidney.   this came up another time on this board.

[mikesimon]

I've been thinking about your post since yesterday. The increased creatinine make me think kidney but the elevated enzymes, particularly ALT point to liver. I'm sure you are well aware of the signs of rejection so I assume you have no fever and no pain around the kidney. My own experience has been that creatine isn't affected as much by the hep c as it is the Prograf dose. I am a liver transplant recipient so I have a general idea of what you're going through. And I know it is terribly frightening to be in your situation. I've agonized over these issues myself and though I will tell you to relax and try to forget about it till Friday I know that's practically impossible. I do think that your doctors will figure this out and treat you effectively. Just hang in there and stay positive as best you can. If your hospital fast tracks the biopsy you may have the results as early as Friday. I once went in on a Saturday for biopsy around 8 am and was diagnosed with accute rejection later in the day. I was treated with solumedrol that day and returned home Sunday. Then everything was fine and I have had no rejection since. So they can fix a lot of these things with the drugs available. I wish you the very best Gary. Good luck. Mike

[garyford]

yes, it does sound like we have alot of issues in common. The creatine went up when I was staying off drinking fluids to try and get the excess fluid off my heart and lungs. I don't feel its the kidney either. My prograf level has been steady at 10 for a long time and all of a sudden it jumped to 20 and I think that is what caused alot of problems. Creatine, liver enzyems and prograf levels all went up at about the same time. I go to the doctor once a month and everything went from total normal to haywire. Does prograf clear though the kidneys or liver, that would probably be a good indication where the problem might be. Thanks for all the help, and by the way, I've always had a positive outlook. Win, lose or draw, I know where I'm going one day. I'll keep you guys in my prayers too. Gary

[imkindly]

Gary, here's a link that you might want to look at:

http://home.eznet.net/~webtent/tacro.html

(All about the pharmokinetics of prograf)
There's 2 main issues-

1. prograf is metabolized by the liver

2. one of the side effects of prograf is nephrotoxicity

Also, some drugs interact with prograf (can alter the levels)

Be sure to check out the link above.



P.S.-
Just curious---
Did your doctors warn you about taking NSAIDs?  (NSAIDs + Prograf = increased likelyhood of kidney failure)
Avoid NSAIDs

[mikesimon]

You certainly do have a great attitude. Good luck and please keep us posted on your situation. Mike

[garyford]

Thanks for the help, I'm thinking the liver is what caused the prograf levels to spike all of a sudden, since it is cleared by the liver. Then it gave the kidney problems, I'm currently taking half of the dosage of prograf and its back down to normal range 11.2 Just don't understand why all of a sudden the liver is acting up, everything has been normal for 15 years and now this big spike of ast/alt. I hope it will come back down and things will straighten up on their own. Again, thanks so much for the info, this is a great site. Wonder if I should wait on the kidney biopsy now??  Let you know probably Monday as they want to keep me Friday and Saturday for observation.