Hep C w/cirrhosis

My brother has hep c with cirrhosis.  The doctor says cirrhosis is Grade A ? meaning it is now stable.  He wants to do the TIPS procedure.  My brother already has encepalopathy which is mostly controlled by lactulose.  We know the TIPS makes encepalopathy worse.  Right now he has no bleeding varices.  He just had an endoscopy.  Dr. said he wants to do the TIPS then hopefully do treatment with interferon/ribavarin.  Is it necessary to do TIPS?  He is not on a transplant list.  Dr. says when he goes to Grade B they put him on the list.  An associate of this doctor said my bother should not be in a hurry to do TIPS because of encepalopathy.  What is your opinion of this procedure and can you do treatment without the TIPS?  Also, I am considering being tested for the live donor although I am 62 and am not sure if I could qualify.  What do you think about the live donors and can you get a new liver w/o treatment for hep C or w/o hep c being cured?  

[Douglas Dieterich, MD]

It sounds like your brother by definition is already a Childs B if he has ascites and likely has varices if the doc is recommending a TIPSS. He needs to be at a transplant center before anything else is done at all. The advocate is correct about MELD score, but this is clearly decompensated cirrhosis and needs to be seen at a center where he can be evaluated for transplant. You are slightly old for  live donor, by the way. Good luck to both of you! DTD

[patientadvocate]

If your brother has ascites (which I am assuming since they want to do a TIPS) and encephalopathy he is not grade A - he is grade B or C.  But more important, for transplant purposes we now use the MELD score (ask his doctor what the MELD score is).  The A,B,C score is the Child Pugh Score.  I suggest your brother gets a second opinion from a hepatologist at a transplant center.    

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