cirrohsis of the liver

when you have cirrohsis of the liver (stage 4)what determines a liver transplant?

[Bill1954]

Hi Ann—

Sorry to hear of your problem. Liver transplantation is a complex issue, but need is generally determined by something called ‘MELD’ score.

Cirrhosis is broken into two basic stages; compensated and decompensated. What more can you tell us about your diagnosis; how long ago were you diagnosed, is it a result of HCV, etc.

Welcome to the discussion group,

Bill

[GrandOak]

As Bill pointed out, the MELD score is the primary mark used to determine when you get placed upon the waiting list.

You also should be getting routine exams (6 month or at least annually) to compute MELD from you blood work as well as to check AFP  and LFT (ALT, AST, etc.).  Alpha-Fetoprotein (AFP) is a cancer marker to see if HCC could be present.

In addition to MELD you should have liver scanned (CT or Ultra-Sound) to see if there are lesions as well as Endoscopy to check for varices.  Frequency of scans varies depending on what they reveal.  Most are done at least once a year.

There also is a Bone Density scan which should be regularily done too.

[belle64]

I also have stage 4 cirrhosis.  What number on the MELD score determines whether you should get a transplant? Or if you could tell me how to compute it, the only information the clinic gives me is my bilirubin count.
Belle64

[Bill1954]

Hi Belle—

I believe the parameters for transplant vary considerably from state to state; in Northern California right now, I think a MELD of 15 is needed to be considered for TP; and possibly as high as mid thirties to receive an organ from UNOS. There’s obviously more to the decision; here’s a link to the center I treated with, and a page that discusses their requirements:

http://www.cpmc.org/advanced/liver/patients/topics/transplant.html

However, keep in mind your center might follow different guidelines.

A link to a MELD calculator here; you’ll need recent INR, bilirubin and creatinine results:

http://www.mayoclinic.org/meld/mayomodel6.html

Good luck and take care—

--Bill

[IAmTheWalrus]

Different transplant centers have different criteria for minimum MELD score to be on the transplant list. Actually it is more complicated than just a MELD score. There are other factor to be considered that may add additional points to the laboratory-determined MELD score, like HCC for instance.

Having a MELD score that gets you on the list is different than the MELD score that will get you to the top of the list and receive a donor organ. You can find out much more about this process at the UNOS/OPTN website. One of the most interesting things there for me are the data for the locations (states/regions) and transplant centers that show MELD scores at actual transplant. From these data you can get a pretty good idea of where you stand on the list.

So far, in 2010 in the U.S., there have been 2,998 liver transplants performed using deceased nonor (not living donor tranaplants). Of those:

-  about 200 (6.67%) went to patients that are "Status 1"
-  36 (1.2%) for patients with MELD < 10
-  299 (10%) for patients with MELD = 11-18
-  906 (30%) for patients with MELD = 19-24
-  1554 (52%) for patients with MELD = 25+

The majority of patients are transplanted at MELD of 25+

These figures are extrapolated for the latest data reported by UNOS/OPTN

[IAmTheWalrus]

At the UNOS/OPTN website, you can get this same sort of breakdown by region, state or transplant center.

http://optn.transplant.hrsa.gov/latestData/viewDataReports.asp

[belle64]

Can I return to a normal lifestyle after a transplant?  And, what is the survival rate? It sounds like a dangerous surgery.

[GoofyDad]

Belle:

Might you be putting the cart before the horse? Not all cirrhosis cases end up needing a TP. Do you have HepC? Have you treated it?

[IAmTheWalrus]

Belle,

You should probably start a new thread with questions you have. Go to the top of the screen and click on the green "post a question" icon

For me transplant was very successful and I can do anything now that I did before. Really no problems at all. I take very little in the way of immunisuppression drugs and I feel fine. I still have HepC. A transplant does not cure that, but it can buy time if the liver has failed. I hope to treat for HepC soon with the new PI drugs.

GoffyDad is right in my opinion. If you have HepC, then deal with that first and you may avoid the cost and risks of the transplant list and surgery.

Brent