worried about lab work

[mary921]

had lab work done, GGT and ALT are sky high, and it keeps rising,
bili high. hep c over 6 million. on celcept, was on prograff for 7 years, changed to celcept last month, levels are still low.
very depressed.

[nygirl7]

I have no idea what those medications are.  Are you on treatment to get rid of the hep?  With high liver enzymes there is a lot of cell death and damage being done to your liver. Have you had a biopsy to see what stage you are?

[mikesimon]

She's a transplant recipient and the drugs are anti-rejection drugs. Mike

[nygirl7]

Now that makes much more sense - I couldn't figure out what the heck they were!

[Jeff88]

Mary, I have been there, ALT/AST in the 700-900, viral load > 50 mln.

There may be two reasons for this: it may be a rejection episode or it may be HepC out of control. A biopsy should show what it is. After they find what it is, they will need either to stop rejection or to put you on interferon. I was in this situation two years ago, initially they thought it was rejection and increased my prograf and added prednison. It made things worse. I consulted another Doc who suggested that it is not a rejection and put me on IFN. This finally got my liver numbers near the normal range and lower the VL.

I think the most important thing you can do now is to get a second opinion from an experienced hepatologist. Ask family, friends to help you find and arrange for such a consultation.

The very best of luck to you. Jeff.

[mikesimon]

Your situation is complicated to say the least. I just found your reply to the previous thread and see that your viral load decreased and then increased while you were on treatment. Your response was not really encouraging, notwithstanding the fact that initially you did have a decrease in VL. I believe that your decrease was not as rapid as we'd like to see, even in a transplant recipient. You said you were on full doses of Pegasys and ribavirin. The standard dose for Pegasys is 180 micrograms but I have seen transplant patients on lower doses - 135 mcg for example. The ribavirin is weight dosed but I have seen a lot of lower than optimal doses of that drug in the transplant population. Impaired renal/kidney function does warrant a lower dose so the optimal dose must be considered in the context of renal function. But, even assuming your doses were not optimal I still wouldn't expect to see a viral increase like you described if you really were having a response to treatment. And I am a little suspicious that your HCV would cause the itching which is often the result of bile buildup in the blood unless you have developed cholestatic hepatitis. Is cholestatic hepatitis the part of the diagnosis your doctor told you that you said you could not remember?
It does appear that re-transplantation for HCV is often not very successful in terms of longevity but, from what I have read, the prognosis is slightly better if the re-transplantation is farther away in time from the original transplant. I am not surprised that your doctors don't believe you would be a candidate so the focus becomes - get you better. Without knowing anything more than what you've said my advice is to push push push your doctors for information and new approaches to get you well. Read everything you can about transplantation, HCV, bilirubin, cholestatic hepatitis and anything else that occurs to you and let your doctors know you know a little about what is going on with you. Like life - the squeaky wheel gets the grease. I cannot begin to tell you how loudly I squeaked and how often I squeaked. But, I got attention and good treatment. I wish you the very best luck Mary. Do not give up Mary. I feel deeply for you. Mike

[mary921]

bridgeing fibrosis is the other thing the biopsy showed.
talked with doctor today, she upped my prograff to 2mg bid.
ordered 24 hr urine.
repeat bld wk in 2 weeks.

[mikesimon]

I understood from your post that they switched you from Prograf to Cellcept. Did I misunderstand? Are you on one or the other or are you on both? Mike