liver biopsy

[patknight]

Has anyone out there been told they need a liver transplant without a liver biopsy?  My husband has not had one done but they say he is in liver failure and needs a transplant.  How can they be so sure without a biopsy?

[HCA]

They can tell all right.
Look up MELD (measure of end stage liver disease)
and Child-Pugh cirrhosis scoring system.
They rely mainly (but not exclusively) on bio-chemistry.
Plunging a needle into an end stage liver is not a good idea because of bleeding.

[HCA]

I should have added that a biopsy can only confirm the prescence of cirrhosis but cannot reveal the degree of decompensation and so has no role in the transplant evaluation process.

[newleaf09]

Agree with HCA.  No biopsy needed if MELD score (done with bloodwork results) is bad or Child-Pugh class is B (I think) or C.  Child Pugh (used to rate cirrhosis and advanced liver disease) is figured with bloodwork results but also with the addition of ascites (fluid in abdomen) and brain fog.

Slow clotting and low platelets are typical bloodwork signs of cirrhosis, but the physical signs of ascites, brain fog and varices indicate that the liver is actually failing and patient's condition is thought to be too risky to withstand biopsy and standard treatment for hepatitis C and needs to be evaluated for transplant.  

[Bill1954]

I agree whole heartedly with the comments above; a biopsy might cause more harm than good in a decompensated patient.

You mentioned going to San Francisco in another thread; do you mind me asking who you are seeing there to get listed? California Pacific Medical Center is an outstanding outfit in SF; it’s headed up by a Dr Robert Gish, who is well regarded internationally.

Is the meat-free diet you mentioned prescribed by a medical doctor? I believe a certain amount of protein is necessary to maintain liver synthesis; as long as his doctor’s are aware of this, it should be fine.

As Mikesimon mentioned in another thread, Rifomaxin, along with Neomycin are sometimes prescribed for encephalopathy management.

Medscape has an excellent article on management techniques:

http://emedicine.medscape.com/article/186101-overview

Best of luck to you both—


Bill

[mikesimon]

I never had ascites, edema, brain fog (encephalopathy). I did have variceal bleeding on 2 occasions and 5 years later I had a liver transplant. I never had a biopsy pre-transplant but they knew I needed one 5 years before I got my liver. And that was just luck - they mistakenly thought I had cancer.
Mike